Published online Jan 16, 2020. doi: 10.4253/wjge.v12.i1.42
Peer-review started: May 10, 2019
First decision: May 31, 2019
Revised: September 19, 2019
Accepted: November 6, 2019
Article in press: November 6, 2019
Published online: January 16, 2020
Processing time: 223 Days and 11.1 Hours
Esophagogastric leakage is one of the most severe postoperative complications. Partial disruption of the anastomosis, can be successfully treated with an endoscopic vacuum assisted closure (E-VAC). The advantage of that method of treatment is the ability to adjust a vacuum dressing individually to the size of the dehiscence and thus to reduce the risk of a secondary fistula or abscess. The authors present two patients with postoperative gastroesophageal leakage treated successfully with E-VAC.
Two male patients developed a potentially life threatening esophagogastric leakage. Patient A underwent resection of the distal half of the esophagus and upper part of the stomach due to Siewert type II adenocarcinoma of the gastroesophageal junction. Proximal resection of the stomach was performed in the patient B after massive bleeding from Mallory-Weiss tears. Both patients were treated successfully with an individually adapted E-VAC with concomitant correction of fluid and electrolyte disturbances, and treatment of sepsis with appropriate antibiotics.
Endoscopic vacuum closure is an effective alternative to endoscopic stenting or relaparotomy. Through individual approach it allows a more accurate assessment of healing.
Core tip: Postoperative esophagogastric leakage might be successfully treated with conservative measures either with well-established endoscopic stenting or endoscopic vacuum assisted closure with respect to the type and localization of leakage. The advantage of vacuum treatment is a continuous evacuation of septic discharge and an individual adjustment of the dressing depending on the size of the dehiscence. The application of an endoscopic vacuum dressing is relatively simple, cost-effective, easily accessible and in many cases, it avoids consecutive laparotomies.