E-VAC therapy as treatment of complications in gastrointestinal surgery in a gastroenterology reference center in Colombia: Case series
DOI:
https://doi.org/10.47892/rgp.2023.432.1472Keywords:
Digestive System Fistula, Surgical Wound Dehiscence, Negative-Pressure Wound TherapyAbstract
Gastrointestinal postoperative anastomotic leaks and fistulas occur frequently and many are managed surgically; however, endoscopic interventions have shown to improve healing outcomes and length of hospital stay. The experience of vacuum-assisted closure therapy (E-VAC) is described, in complications such as fistulas and postoperative anastomotic leaks, in a gastrointestinal reference center in Colombia. A case series study was carried out in patients with anastomotic leaks and fistulas at different levels of the digestive tract, treated by E-VAC, by the Gastroenterology Service in Colombia, during a period from February 2019 to November 2021. Sociodemographic, clinical and surgical variables were described. 6 cases are described, 4 from lower digestive tract and 2 from upper digestive tract. 83% were men; the mean age was 51.8 years (+/-17.5). The indication for E-VAC was colorectal anastomotic fistula in 66%; the most frequent anatomical location was near the anal region (66%), less frequently at the level of the cardia (16%) and esophagus (16%). The size of the defect was described between 20 and 80% in patients undergoing E-VAC therapy, with an average hospitalization length of stay of 22.5 days, with an average number of exchanges of seven per patient. Anastomotic leaks and fistulas are potentially fatal complications in gastrointestinal surgery. E-VAC therapy has shown to be effective and safe, promoting defect closure and drainage of collections present, also decreasing the length of hospital stay.
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Li, C. & Zhao, Y. & Han, Z. & Zhou, Y.. (2016). Anastomotic leaks following gastrointestinal surgery: Updates on diagnosis and interventions. 9. 7031-7040.
Goenka MK, Goenka U. Endotherapy of leaks and fistula. World J Gastrointest Endosc. 2015 Jun 25;7(7):702-13. doi: 10.4253/wjge.v7.i7.702.
de Moura DTH, de Moura BFBH, Manfredi MA, Hathorn KE, Bazarbashi AN, Ribeiro IB, de Moura EGH, Thompson CC. Role of endoscopic vacuum therapy in the management of gastrointestinal transmural defects. World J Gastrointest Endosc. 2019 May 16;11(5):329-344. doi: 10.4253/wjge.v11.i5.329.
Laukoetter MG, Mennigen R, Neumann PA, Dhayat S, Horst G, Palmes D, Senninger N, Vowinkel T. Successful closure of defects in the upper gastrointestinal tract by endoscopic vacuum therapy (EVT): a prospective cohort study. Surg Endosc. 2017 Jun;31(6):2687-2696. doi: 10.1007/s00464-016-5265-3. Epub 2016 Oct 5.
Borstlap WAA, Musters GD, Stassen LPS, van Westreenen HL, Hess D, van Dieren S, Festen S, van der Zaag EJ, Tanis PJ, Bemelman WA. Vacuum-assisted early transanal closure of leaking low colorectal anastomoses: the CLEAN study. Surg Endosc. 2018 Jan;32(1):315-327. doi: 10.1007/s00464-017-5679-6. Epub 2017 Jun 29.
Morell, B., Murray, F., Vetter, D., Bueter, M., & Gubler, C. (2019). Endoscopic vacuum therapy (EVT) for early infradiaphragmal leakage after bariatric surgery—outcomes of six consecutive cases in a single institution. Langenbeck’s Archives of Surgery. doi:10.1007/s00423-019-01750-9.
Seyfried, F., Reimer, S., Miras, A., Kenn, W., Germer, C.-T., Scheurlen, M., & Jurowich, C. (2013). Successful treatment of a gastric leak after bariatric surgery using endoluminal vacuum therapy. Endoscopy, 45(S 02), E267–E268. doi:10.1055/s-0033-1344569.
Rubicondo, C., Lovece, A., Pinelli, D. et al. Endoluminal vacuum-assisted closure (E-Vac) therapy for postoperative esophageal fistula: successful case series and literature review. World J Surg Onc 18, 301 (2020). https://doi.org/10.1186/s12957-020-02073-6.
Borejsza-Wysocki M, Szmyt K, Bobkiewicz A, et al. Endoscopic vacuum-assisted closure system (E-VAC): case report and review of the literature. Wideochir Inne Tech Maloinwazyjne. 2015;10(2):299-310. doi:10.5114/wiitm.2015.52080.
Weidenhagen, R., Gruetzner, K.U., Wiecken, T. et al. Endoscopic vacuum-assisted closure of anastomotic leakage following anterior resection of the rectum: a new method. Surg Endosc 22, 1818–1825 (2008). https://doi.org/10.1007/s00464-007-9706-x.
Jagielski, M., Piątkowski, J., Jarczyk, G. et al. Transrectal endoscopic drainage with vacuum-assisted therapy in patients with anastomotic leaks following rectal cancer resection. Surg Endosc (2021). https://doi.org/10.1007/s00464-021-08359-4.
Kumar Goenka, M., Ashokrao Rodge, G., & Goenka, U. (2020). Endoscopic Management of Leaks and Fistula in Gastrointestinal Tract. Advanced Endoscopy. doi:10.5772/intechopen.87144.
Jung, D.H.; Yun, H.-R.; Lee, S.J.; Kim, N.W.; Huh, C.W. Endoscopic Vacuum Therapy in Patients with Transmural Defects of the Upper Gastrointestinal Tract: A Systematic Review with Meta-Analysis. J. Clin. Med. 2021, 10, 2346. https://doi.org/10.3390/jcm10112346.
Sharp G, Steffens D, Koh CE. Evidence of negative pressure therapy for anastomotic leak: a systematic review. ANZ J Surg. 2021 Apr;91(4):537-545. doi: 10.1111/ans.16581. Epub 2021 Jan 22.
Popivanov, G.I., Mutafchiyski, V.M., Cirocchi, R., Chipeva, S.D., Vasilev, V.V., Kjossev, K.T. and Tabakov, M.S. (2020), Endoluminal negative pressure therapy in colorectal anastomotic leaks. Colorectal Dis, 22: 243-253. https://doi.org/10.1111/codi.14754.
Restrepo, Juliana, Benito, Erika, Aramendiz, María-Conchita, & Pinilla, Raúl. (2020). Colorectal anastomotic leak treated with E-VAC with polyvinyl sponge could reduce treatment time. Revista de Gastroenterología del Perú, 40(4), 355-360. https://dx.doi.org/10.47892/rgp.2020.404.1175.
Still S, Mencio M, Ontiveros E, Burdick J, Leeds SG. Primary and Rescue Endoluminal Vacuum Therapy in the Management of Esophageal Perforations and Leaks. Ann Thorac Cardiovasc Surg. 2018;24(4):173-179. doi:10.5761/atcs.oa.17-00107.
Brangewitz, M., Voigtländer, T., Helfritz, F., Lankisch, T., Winkler, M., Klempnauer, J. Wedemeyer, J. (2013). Endoscopic closure of esophageal intrathoracic leaks: stent versus endoscopic vacuum-assisted closure, a retrospective analysis. Endoscopy, 45(06), 433–438. doi:10.1055/s-0032-1326435.
Leeds, S.G., Mencio, M., Ontiveros, E. et al. Endoluminal Vacuum Therapy: How I Do It. J Gastrointest Surg 23, 1037–1043 (2019). https://doi.org/10.1007/s11605-018-04082-z.
Morell B, Murray F, Vetter D, Bueter M, Gubler C. Endoscopic vacuum therapy (EVT) for early infradiaphragmal leakage after bariatric surgery-outcomes of six consecutive cases in a single institution. Langenbecks Arch Surg. 2019 Feb;404(1):115-121. doi: 10.1007/s00423-019-01750-9. Epub 2019 Jan 15.
Jagielski M, Piątkowski J, Jarczyk G, Jackowski M. Transrectal endoscopic drainage with vacuum-assisted therapy in patients with anastomotic leaks following rectal cancer resection. Surg Endosc. 2021 Mar 1. doi: 10.1007/s00464-021-08359-4. Epub ahead of print.
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