Endoluminal vacuum therapy for gastrojejunal anastomotic leaks after Roux-en-Y gastric bypass: a pilot study in a swine model

Scott, Robert G.; Ritter, L; Shada, Amber L.; Feldman, Sanford H.; Kleiner, Daniel

doi:10.1007/s00464-016-4823-z

Cited by 10 publications

(8 citation statements)

References 25 publications

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“…To comprehensively analyze the risk factors of anastomotic leak, first of all, it is emphasized that a precise and scrupulous surgical technique plays a decisive role in the healing of anastomotic tissue. Precise surgical operation needs to ensure firm and stable tissue closure, good blood supply to the stomach or other organs replacing the esophagus and targeted treatment of anastomotic tension 3–7 . At present, gastric conduit, especially the thin conduit replacing the esophagus, has been accepted by more and more surgeons.…”

Section: Complex Clinical Presentations and Possible Causes Of Anasto...mentioning

confidence: 99%

“…Compared with the control pigs, the experimental pigs treated with intraluminal vacuum were killed on the seventh day. It was observed that the defect had healed, showing outstanding therapeutic value 66 . Virgilio et al reviewed 29 research reports on EVT (ENPT) in the treatment of upper gastrointestinal anastomotic leak in 2018, comprising 209 patients with 17 retrospective studies, six prospective studies and six case reports.…”

Section: Negative Pressure and Endoluminal Vacuum Therapy (Evt E‐vat)mentioning

confidence: 99%

“…It was observed that the defect had healed, showing outstanding therapeutic value. 66 Virgilio et al reviewed 29 research reports on EVT (ENPT) in the treatment of upper gastrointestinal anastomotic leak in 2018, comprising 209 patients with 17 retrospective studies, six prospective studies and six case reports. The conclusion is clear and definite.…”

Section: Negative Pressure and Endoluminal Vacuum Therapy ( ...mentioning

confidence: 99%

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Update on therapeutic strategy for esophageal anastomotic leak: A systematic literature review

et al. 2022

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Anastomotic leak is still a severe complication in esophageal surgery due to high mortality. This article reviews the updates on the treatment of anastomotic leak after esophagectomy in order to provide reference for clinical treatment and research. The relevant studies published in the Chinese Zhiwang, Wanfang, and MEDLINE databases to December 21, 2021 were retrieved, and esophageal carcinoma, esophagectomy, anastomotic leakage, and fistula selected as the keywords. A total of 78 studies were finally included. The treatments include traditional surgical drainage, new reverse drainage trans-fistula, stent plugging, endoscopic clamping, biological protein glue injection plugging, endoluminal vacuum therapy (EVT), and reoperation, etc. Early diagnosis, accurate classification and optimal treatment can promote the rapid healing of anastomotic leaks. EVT may be the most valuable approach, simultaneously with good commercial prospects. Reoperation should be considered in patients with complex fistula in which conservative treatment is insufficient or has failed.

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Section: Complex Clinical Presentations and Possible Causes Of Anasto...mentioning

confidence: 99%

Section: Negative Pressure and Endoluminal Vacuum Therapy (Evt E‐vat)mentioning

confidence: 99%

Section: Negative Pressure and Endoluminal Vacuum Therapy ( ...mentioning

confidence: 99%

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Update on therapeutic strategy for esophageal anastomotic leak: A systematic literature review

et al. 2022

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“…However, all comparisons with other studies should be treated with caution, since both the measuring methods and the organs examined differed from these used in our experiment. A comparable study by Scott et al in a porcine model of anastomotic leakage after Roux-en-Y gastric bypass demonstrated that the histological specimen from EndoVAC treated pigs had lesser degree of severe inflammation and no signs of necrosis or ischemia when compared with the control group [ 45 ]. Scott et al was able to confirm these results also in a porcine model for esophagectomy [ 46 ] indirectly supporting our findings of improved tissue oxygenation upon EndoVAC therapy.…”

Section: Discussionmentioning

confidence: 99%

Effects of endoluminal vacuum sponge therapy on the perfusion of gastric conduit in a porcine model for esophagectomy

Felinska,

Studier-Fischer,

Özdemir

et al. 2024

Surg Endosc

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Background After esophagectomy, the postoperative rate of anastomotic leakage is up to 30% and is the main driver of postoperative morbidity. Contemporary management includes endoluminal vacuum sponge therapy (EndoVAC) with good success rates. Vacuum therapy improves tissue perfusion in superficial wounds, but this has not been shown for gastric conduits. This study aimed to assess gastric conduit perfusion with EndoVAC in a porcine model for esophagectomy. Material and methods A porcine model (n = 18) was used with gastric conduit formation and induction of ischemia at the cranial end of the gastric conduit with measurement of tissue perfusion over time. In three experimental groups EndoVAC therapy was then used in the gastric conduit (− 40, − 125, and − 200 mmHg). Changes in tissue perfusion and tissue edema were assessed using hyperspectral imaging. The study was approved by local authorities (Project License G-333/19, G-67/22). Results Induction of ischemia led to significant reduction of tissue oxygenation from 65.1 ± 2.5% to 44.7 ± 5.5% (p < 0.01). After EndoVAC therapy with − 125 mmHg a significant increase in tissue oxygenation to 61.9 ± 5.5% was seen after 60 min and stayed stable after 120 min (62.9 ± 9.4%, p < 0.01 vs tissue ischemia). A similar improvement was seen with EndoVAC therapy at − 200 mmHg. A nonsignificant increase in oxygenation levels was also seen after therapy with − 40 mmHg, from 46.3 ± 3.4% to 52.5 ± 4.3% and 53.9 ± 8.1% after 60 and 120 min respectively (p > 0.05). An increase in tissue edema was observed after 60 and 120 min of EndoVAC therapy with − 200 mmHg but not with − 40 and − 125 mmHg. Conclusions EndoVAC therapy with a pressure of − 125 mmHg significantly increased tissue perfusion of ischemic gastric conduit. With better understanding of underlying physiology the optimal use of EndoVAC therapy can be determined including a possible preemptive use for gastric conduits with impaired arterial perfusion or venous congestion. Graphical abstract

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“…• снижение локального интерстициального отёка тканей, снижение межклеточного давления, усиление местного лимфообращения и транскапиллярного транспорта, что увеличивает скорость формирования грануляционной ткани [12];…”

Section: Discussionunclassified

Features of therapeutic tactics for the failure of gastrointestinal anastomosis in patients with morbid obesity after Roux-en-Y gastric bypass

Stankevich

Smirnov

Zlobin

et al. 2023

Journal of Clinical Practice

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Background: Roux-en-Y gastric bypass is the main type of bariatric surgery. The most formidable and severe complication in morbid obesity patients after gastric bypass is gastrojejunostomy leak. Aim: to study the possibilities of improving treatment outcomes of obese patients during gastrojejunostomy leak after gastric bypass surgery using new minimally invasive methods. Methods: This retrospective cohort descriptive study included all patients with gastrojejunostomy leak after gastric bypass treated in the Department of Surgery of the Federal State Budgetary Institution Federal Scientific and Practical Center of the Federal Medical and Biological Agency of Russia in 20192022. In total, 445 gastric bypasses were performed during this period, and seven patients (1.6%) developed HEA failure in the postoperative period. Results: The results of treatment of gastroenteroanastomotic leaks during gastric bypass in patients with morbid obesity are presented. The early diagnosis of gastroenteroanastomosis failure in this category of patients was difficult. All doubts in the diagnosis of anastomotic failure should be completed by revision laparoscopy with intraoperative esophagogastroscopy. Minimally invasive techniques (surgical, endoscopic), drug therapy, and adequate nutritional support are crucial for managing patients with anastomotic leaks. Conclusion: The use of an endoscopic intraluminal vacuum aspiration system in the treatment of gastroenteroanastomotic insufficiency avoids the spread of inflammation in the abdominal cavity, accelerates the reparative process in the area of insufficiency, and, in most cases, avoids programmed sanitation, significantly improving the treatment results.

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Endoluminal vacuum therapy for gastrojejunal anastomotic leaks after Roux-en-Y gastric bypass: a pilot study in a swine model

Cited by 10 publications

References 25 publications

Update on therapeutic strategy for esophageal anastomotic leak: A systematic literature review

Update on therapeutic strategy for esophageal anastomotic leak: A systematic literature review

Effects of endoluminal vacuum sponge therapy on the perfusion of gastric conduit in a porcine model for esophagectomy

Features of therapeutic tactics for the failure of gastrointestinal anastomosis in patients with morbid obesity after Roux-en-Y gastric bypass

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