Endoluminal vacuum-assisted closure (E-Vac) therapy for postoperative esophageal fistula: successful case series and lit
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(2020) 18:301
CASE REPORT
Open Access
Endoluminal vacuum-assisted closure (EVac) therapy for postoperative esophageal fistula: successful case series and literature review Carolina Rubicondo1* , Andrea Lovece2, Domenico Pinelli1, Amedeo Indriolo3, Alessandro Lucianetti2 and Michele Colledan1
Abstract Background: Treatment of esophageal perforations and postoperative anastomotic leaks of the upper gastrointestinal tract remains a challenge. Endoluminal vacuum-assisted closure (E-Vac) therapy has positively contributed, in recent years, to the management of upper gastrointestinal tract perforations by using the same principle of vacuum-assisted closure therapy of external wounds. The aim is to provide continuous wound drainage and to promote tissue granulation, decreasing the needed time to heal with a high rate of leakage closure. Cases presentation: A series of two different cases with clinical and radiological diagnosis of esophageal fistulas, recorded from 2018 to 2019 period at our institution, is presented. The first one is a case of anastomotic leak after esophagectomy for cancer complicated by pleuro-mediastinal abscess, while the second one is a leak of an esophageal suture, few days after resection of a bronchogenic cyst perforated into the esophageal lumen. Both cases were successfully treated with E-Vac therapy. Conclusion: Our experience shows the usefulness of E-Vac therapy in the management of anastomotic and nonanastomotic esophageal fistulas. Further research is needed to better define its indications, to compare it to traditional treatments and to evaluate its long-term efficacy. Keywords: E-Vac therapy, Oesophageal fistula, Oesophageal leaks, Anastomotic leaks, Bronchogenic cyst
Background Esophageal perforations and postoperative esophageal anastomotic leaks are still a life-threatening condition; the reported mortality ranges from 10 to 25%, when therapy is started within 24 h, and from 40 to 60%, when the treatment is delayed [1]. Iatrogenic perforation is the leading cause of esophageal perforations, accounting for around 60% of all cases. Less frequent causes are trauma at the upper abdomen or chest, Boerhaave’s syndrome, or spontaneous perforations * Correspondence: [email protected] 1 General Surgery III, ASST Papa Giovanni XXIII, Bergamo, Italy Full list of author information is available at the end of the article
induced by straining and vomiting [2]. Esophageal anastomotic leak remains one of the most devastating complications after esophagectomy and gastrectomy, with a wide range of reported incidences from 0 to 35% after esophagectomy and 2.7 to 12.3% after total gastrectomy [3]. The key point of a correct treatment includes resuscitation of the patient, assessment of the defect, and timely decision-making [4, 5]. Surgical revision is usually challenging and carries a high risk of severe secondary complications. In the last few years, endoscopy has gained a primary role in both diagnosis and treatment of esophageal perforations and leaks. Several minimally invasive t
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