Results of endoscopic vacuum-assisted closure device for treatment of upper GI leaks
| Autor: | Till Herbold, Wolfgang Schröder, Hakan Alakus, Hans F. Fuchs, Christiane J. Bruns, Martin K. H. Maus, Marc Bludau, Arnulf H. Hölscher, Seung-Hun Chon, Felix Popp, Jessica M. Leers |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Spontaneous Perforation Rectum Anastomotic Leak Sepsis 03 medical and health sciences 0302 clinical medicine Gastrectomy Internal medicine medicine Humans Endoscopic stenting Aged Retrospective Studies Aged 80 and over Esophageal Perforation business.industry Retrospective cohort study Endoscopy Equipment Design Hepatology Middle Aged medicine.disease Mediastinitis Surgery medicine.anatomical_structure Treatment Outcome 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Female business Negative-Pressure Wound Therapy Abdominal surgery |
| Zdroj: | Surgical endoscopy. 32(4) |
| ISSN: | 1432-2218 |
| Popis: | Esophageal perforations and postoperative leakage of esophagogastrostomies are considered to be life-threatening conditions due to the potential development of mediastinitis and consecutive sepsis. Vacuum-assisted closure (VAC) techniques, a well-established treatment method for superficial infected wounds, are based on a negative pressure applied to the wound via a vacuum-sealed sponge. Endoluminal VAC (E-VAC) therapy as a treatment for GI leakages in the rectum was introduced in 2008. E-VAC therapy is a novel method, and experience regarding esophageal applications is limited. In this retrospective study, the experience of a high-volume center for upper GI surgery with E-VAC therapy in patients with leaks of the upper GI tract is summarized. To our knowledge, this series presents the largest patient cohort worldwide in a single-center study. Between October 2010 and January 2017, 77 patients with defects in the upper gastrointestinal tract were treated using the E-VAC application. Six patients had a spontaneous perforation, 12 patients an iatrogenic injury, and 59 patients a postoperative leakage in the upper gastrointestinal tract. Complete restoration of the esophageal defect was achieved in 60 of 77 patients. The average duration of application was 11.0 days, and a median of 2.75 E-VAC systems were used. For 21 of the 77 patients, E-VAC therapy was combined with the placement of self-expanding metal stents. This study demonstrates that E-VAC therapy provides an additional treatment option for esophageal wall defects. Esophageal defects and mediastinal abscesses can be treated with E-VAC therapy where endoscopic stenting may not be possible. A prospective multi-center study has to be directed to bring evidence to the superiority of E-VAC therapy for patients suffering from upper GI defects. |
| Databáze: | OpenAIRE |
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