scholarly journals Endoscopic vacuum therapy in salvage and standalone treatment of gastric leaks after bariatric surgery

2021 ◽  
Author(s):  
Ahrens Markus ◽  
Beckmann Jan Henrik ◽  
Reichert Benedikt ◽  
Hendricks Alexander ◽  
Becker Thomas ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Revision Surgery ◽  
Healing Rate ◽  
Revisional Surgery ◽  
Leakage Rate ◽  
Gastric Leak ◽  
Vacuum Therapy ◽  
External Drainage ◽  
Endoscopic Vacuum Therapy ◽  
Inflammatory Changes

Abstract Introduction Gastric leaks constitute some of the most severe complications after obesity surgery. Resulting peritonitis can lead to inflammatory changes of the stomach wall and might necessitate drainage. The inflammatory changes make gastric leak treatment difficult. A common endoscopic approach of using stents causes the problem of inadequate leak sealing and the need for an external drainage. Based on promising results using endoscopic vacuum therapy (EVT) for esophageal leaks, we implemented this concept for gastric leak treatment after bariatric surgery (Ahrens et al., Endoscopy 42(9):693–698, 2010; Schniewind et al., Surg Endosc 27(10):3883–3890, 2013). Methods We retrospectively analyzed data of 31 gastric leaks after bariatric surgery. For leak therapy management, we used revisional laparoscopy with suturing and drainage. EVT was added for persistent leaks in sixteen cases and was used in four cases as standalone therapy. Results Twenty-one gastric leaks occurred in 521 sleeve gastrectomies (leakage rate 4.0%), 9 in 441 Roux-en-Y gastric bypasses (leakage rate 2.3%), and 1 in 12 mini-bypasses. Eleven of these gastric leaks were detected within 2 days after bariatric surgery and successfully treated by revision surgery. Sixteen gastric leaks, re-operated later than 2 days, remained after revision surgery, and EVT was added. Without revision surgery, we performed EVT as standalone therapy in 4 patients with late gastric leaks. The EVT healing rate was 90% (18 of 20). In 2 patients with a late gastric leak in sleeve gastrectomy, neither revisional surgery, EVT, nor stent therapy was successful. EVT patients showed no complications related to EVT during follow-up. Conclusion EVT is highly beneficial in cases of gastric leaks in obesity surgery where local peritonitis is present. Revisional surgery was unsuccessful later than 2 days after primary surgery (16 of 16 cases). EVT shows a similar healing rate to stent therapy (80–100%) but a shorter duration of treatment. The advantages of EVT are endoscopic access, internal drainage, rapid granulation, and direct therapy control. In compartmentalized gastric leaks, EVT was successful as a standalone therapy without external drainage.

scholarly journals Low-cost modified endoscopic vacuum therapy using a triple-lumen tube allows nutrition and drainage for treatment of an early post–bariatric surgery leak

Endoscopy ◽  
2021 ◽  
Author(s):  
Diogo Turiani Hourneaux de Moura ◽  
Bruno Salomão Hirsch ◽  
Mateus Bond Boghossian ◽  
Flaubert Sena de Medeiros ◽  
Thomas R. McCarty ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Low Cost ◽  
Vacuum Therapy ◽  
Lumen Tube ◽  
Endoscopic Vacuum Therapy ◽  
Post Bariatric Surgery

Endoscopic Vacuum Therapy (EVT)—a New Concept for Complication Management in Bariatric Surgery

2017 ◽  
Vol 27 (9) ◽  
pp. 2499-2505 ◽  
Author(s):  
Fabian Schmidt ◽  
Rudolf Mennigen ◽  
Thorsten Vowinkel ◽  
Philipp A. Neumann ◽  
Norbert Senninger ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Vacuum Therapy ◽  
Complication Management ◽  
Endoscopic Vacuum Therapy

scholarly journals Successful treatment of a gastric leak after bariatric surgery using endoluminal vacuum therapy

Endoscopy ◽  
2013 ◽  
Vol 45 (S 02) ◽  
pp. E267-E268 ◽  
Author(s):  
F. Seyfried ◽  
S. Reimer ◽  
A. Miras ◽  
W. Kenn ◽  
C.-T. Germer ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Successful Treatment ◽  
Gastric Leak ◽  
Vacuum Therapy

Endoscopic Internal Drainage and Low Negative Pressure Endoscopic Vacuum Therapy for anastomotic leaks after oncologic upper gastrointestinal surgery

Endoscopy ◽  
2021 ◽  
Author(s):  
Carlo Jung ◽  
Rachel Hallit ◽  
Annegret Müller-Dornieden ◽  
Melanie Calmels ◽  
Diane Goere ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Treatment Duration ◽  
Treatment Success ◽  
Univariate Analysis ◽  
Gastrointestinal Surgery ◽  
Vacuum Therapy ◽  
Internal Drainage ◽  
Upper Gi ◽  
Endoscopic Internal Drainage ◽  
Endoscopic Vacuum Therapy

Background: Endoscopic internal drainage (EID) with double pigtail stents and low negative pressure endoscopic vacuum therapy (EVT) are treatment options for leakages after upper GI oncologic surgery. We aimed to compare the effectiveness of these techniques. Patients and methods: Between 2016 and 2019, patients treated with EID in five centers in France and with EVT in Göttingen, Germany were included and retrospectively analyzed using univariate analysis. Pigtails were changed every 4 weeks, EVT was repeated every 3-4 days until leak closure. Results: 35 EID and 27 EVT patients were included, with a median leak size of 0.75 cm (0.5-1.5). Overall treatment success was 100% [CI 90; 100] in EID vs. 85.2% [CI 66.3; 95.8] in EVT, p=0.03. The median number of endoscopic procedures was 2 (2; 3) vs. 3 (2; 6.5), p<0.01 and the median treatment duration was 42 (28; 60) vs. 17 days (7.5; 28), p<0.01, for EID vs. EVT, respectively. Conclusion: EID and EVT provide high closure rates for upper GI anastomotic leakages. EVT provides a shorter treatment duration at the cost of a higher number of procedures.

scholarly journals Iatrogenic perforation of esophagus successfully treated with Endoscopic Vacuum Therapy (EVT)

2015 ◽  
Vol 03 (06) ◽  
pp. E547-E551 ◽  
Author(s):  
Gunnar Loske ◽  
Tobias Schorsch ◽  
Christian Dahm ◽  
Eckhard Martens ◽  
Christian Müller
Keyword(s):  
Vacuum Therapy ◽  
Iatrogenic Perforation ◽  
Endoscopic Vacuum Therapy

478 Surgical Endoscopic Vacuum Therapy for Defects of the Upper GI Tract

2015 ◽  
Vol 148 (4) ◽  
pp. S-1110
Author(s):  
Florian Kuehn ◽  
Florian Janisch ◽  
Frank Schwandner ◽  
Guido Alsfasser ◽  
Leif Schiffmann ◽  
...  
Keyword(s):  
Vacuum Therapy ◽  
Gi Tract ◽  
Upper Gi ◽  
Endoscopic Vacuum Therapy ◽  
Upper Gi Tract

Feasibility, Effectiveness, and Safety of Endoscopic Vacuum Therapy for Intrathoracic Anastomotic Leakage Following Transthoracic Esophageal Resection: A Prospective Study

2020 ◽  
Author(s):  
Chengcheng Christine Zhang ◽  
Lukas Liesenfeld ◽  
Rosa Klotz ◽  
Ronald Koschny ◽  
Christian Rupp ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Adverse Events ◽  
Anastomotic Leakage ◽  
Esophageal Resection ◽  
Median Number ◽  
Adverse Event Rate ◽  
Vacuum Therapy ◽  
High Morbidity ◽  
Closure Rate ◽  
Endoscopic Vacuum Therapy

Abstract BackgroundAnastomotic leakage (AL) in the upper gastrointestinal (GI) tract is associated with high morbidity and mortality rates. Especially intrathoracic anastomotic leakage leads to life-threatening adverse events. Endoscopic vacuum therapy (EVT) for anastomotic leakage after transthoracic esophageal resection represents a novel concept. However, sound clinical data are still scarce. This prospective, single-center study aimed to evaluate the feasibility, effectiveness, and safety of EVT for intrathoracic anastomotic leakage following abdomino-thoracic esophageal resection. MethodsFrom March 2014 to September 2019 259 consecutive patients underwent elective transthoracic esophageal resection. 72 patients (27,8 %) suffered from AL. The overall collective in-hospital mortality rate was 3.9% (n=10). Data from those who underwent treatment with EVT were included. ResultsFifty-five patients were treated with EVT. Successful closure was achieved in 89.1% (n=49) by EVT only. The EVT-associated adverse event rate was 5.4% (n=3): bleeding occurred in one patient, while minor sedation-related adverse events were observed in two patients. The median number of EVT procedures per patient was 3. The procedures were performed at intervals of 3-5 days, with a 14-day median duration of therapy. The mortality rate of patients with AL was 7.2% (n=4). Despite successfully terminated EVT, three patients died because of multiple organ failure, acute respiratory distress syndrome, and urosepsis (5.4%). One patient (1.8%) died during EVT due to cardiac arrest. ConclusionsEVT is a safe and effective approach for intrathoracic anastomotic leakages following abdomino-thoracic esophageal resections. It offers a high leakage-closure rate and the potential to lower leakage-related mortalities.

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