| Autor: |
Loske G; Marienkrankenhaus - Department for General, Abdominal, Thoracic and Vascular Surgery, Hamburg, Germany, Hamburg., Rucktaeschel F; Westküstenklinikum Heide - Department for Internal Medicine, Gastroenterology, Hemato-Oncology, Nephrology and Endocrinology, Heide, Schleswig-Holstein, Germany., Schorsch T; Marienkrankenhaus - Department for General, Abdominal, Thoracic and Vascular Surgery, Hamburg, Germany, Hamburg., Moenkemueller K; HELIOS Frankenwaldklinik Kronach - Department of Gastroenterology Kronach, Bayern, Germany., Mueller CT; Marienkrankenhaus - Department for General, Abdominal, Thoracic and Vascular Surgery, Hamburg, Germany, Hamburg. |
| Abstrakt: |
Background and study aims Endoscopic negative pressure therapy (ENPT) is used to close transmural defects in the rectum and esophagus. Very few reports have described ENPT to manage duodenal defects. This study was designed to demonstrate ENPT in a population of 11 patients with transmural duodenal leakages. Patients and methods The method of ENPT was adapted for duodenal use. Open-pore polyurethane-foam or a thin, open-pore double-layered film was wrapped around the distal end of a gastroduodenal tube. First, this open-pore element was placed on the inner wound in the duodenum with endoscopy. Second, continuous negative pressure of -125 mmHg was applied with an electronic pump. Drains were changed after 2 to 7 days. Results Eleven patients were treated with duodenal leaks. Eight defects occurred after operative closure of perforated duodenal ulcers, papillectomy or stricturoplasty, one anastomotic leakage after Billroth - 1 distal gastric resection, one iatrogenic perforation in endoscopic retrograde cholangiopancreatography, and one by a surgical drain. Median duration of therapy was 11 days (range 7 - 24 days). Complete healing of defects was achieved in all patients. Conclusion ENPT is an innovative endoscopic alternative for treatment of transmural duodenal defects. |
