Endoscopic Vacuum-Assisted Closure Therapy in Patients with Anastomotic Leakage after Esophagectomy: A Single-Center Experience

Abstract

Aim To study the efficacy of E-VAC therapy for patients with anastomotic leakage after esophagectomy. Methods Between January 2013 and April 2017, 12 patients underwent E-VAC therapy for the management of postoperative leakage. Their clinical features and endoscopic procedure details, therapy results, adverse events, and survival were investigated. Results All 12 patients were male and the median age was 57 years (interquartile range 51.5–62.8 years). The reasons for esophageal surgery were esophageal cancer (83.3%), gastrointestinal stromal tumor (8.3%), and esophageal diverticulum (8.3%). Prior to E-VAC therapy, 6 patients had undergone failed primary surgical repair and the median duration from esophagectomy to leakage discovery was 13.5 days (IQR 6–207 days). The median duration of E-VAC therapy was 25 days (IQR 13.5–34.8 days) and the average sponge exchange rate was 2.7 times during the treatment period. After E-VAC therapy, 8 patients (66.7%) had complete leakage closure, 3 (25%) had a decreased leakage size, and 1 (8.3%) was unchanged. The three patients with a decreased leakage size after E-VAC therapy were treated with endoscopic and conservative management without further surgery. Conclusion With proper patient selection, E-VAC therapy is a feasible and safe method for the treatment of anastomotic leakage after esophagectomy.

Endoscopic vacuum therapy for postoperative esophageal leak

“…Thus, we modified the protocol to change the sponge every week in 2018. In a recent study showing good outcomes of EVAC, the authors also changed the sponge every 1 or 2 weeks [22]. The sponge could adhere firmly to the wound bed after prolonged placement.…”

Feasibility, Effectiveness, and Safety of Endoscopic Vacuum Therapy for Intrathoracic Anastomotic Leakage Following Transthoracic Esophageal Resection: A Prospective Study

“…These considered small patient cohorts with only 1-39 patients (12,39,47). The reported success rates of EVT for anastomotic leakages are high (66-100%) (12,13,36,39,(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58). Accordingly, adverse event rates are low (0-14.8%) (12,39,47,51,52).…”

T-drain esophagostomy under thoracoscopy for intrathoracic esophagogastric anastomotic leakage following esophagectomy for esophagogastric junction cancer: A case report

“…Therapies range from aggressive surgical treatment to conservative treatment, although the optimal therapy is still controversial. Conservative therapy, such as placement of chest drains and gastrointestinal tubes, vacuum-assisted closure (VAC), and implantation of self-expanding stents [ [8] , [9] , [10] , [11] , [12] , [13] ], which avoids surgical treatment, is often applied in patients with poor physical condition. Lara Schaheen et al reported that if stenting and wound vacuum are used, undrained mediastinal contamination and persistent leakage require surgical intervention [ 14 ].…”