DOZ047.13: Prophylactic endoscopic esophageal vacuum (EVAC) therapy of high-risk esophageal anastomoses in pediatric surgical patients

Abstract

Abstract Summary Esophageal anastomotic leak (EAL) is a potentially severe complication of surgical procedures of the esophagus. Vacuum-assisted closure (VAC) therapy is increasingly used in the treatment of EAL, with observational studies suggesting it is a highly effective method for esophageal defect closure.1–3 It was hypothesized that prophylactic esophageal VAC (EVAC) placement at the time of new anastomosis creation may improve blood flow and healing, potentially leading to fewer EALs. Methods Between July 2015 and November 2018, patients who underwent surgery that resulted in a new esophageal anastomosis and were deemed to be high risk for anastomotic complications had a prophylactic EVAC placed at the time of surgery. Retrospective review of similar surgical procedures without prophylactic EVAC placement from January 2014 to November 2018 was performed for comparison. Results Thirteen pediatric patients had prophylactic EVAC placement at the time of esophageal repair. Procedures prompting EVAC placement included primary repair of long-gap esophageal atresia (LGEA) by the Foker technique (N = 7), stricture resection after repaired LGEA (N = 3) or type C esophageal atresia (N = 1), and stricture resection after delayed identification of a retained esophageal foreign body (N = 2). Three of 13 patients who had prophylactic EVAC placement (23.1%) experienced EAL in the post-operative period. Two patients were found to have technical failure of their EVAC leading to absence of suction, and one patient experienced delayed EAL 12 days after removal of the EVAC. In comparison, post-surgical EAL occurred in 13 of 58 patients who had the Foker procedure for LGEA and in 8 of 31 patients who had esophageal stricture resection without prophylactic EVAC placement. The rates of EAL in the prophylactic EVAC group were not significantly different from rates of EAL in either the post-surgical Foker (23.1% vs 22.4%, P = 0.999), post-stricture resection (23.1% vs 25.8%, P = 0.999), or combined post-Foker and stricture resection (23.1% vs 23.6%, P = 0.999) groups by Fisher's exact test. Conclusions Prophylactic EVAC placement does not carry increased risk of EAL compared to standard post-surgical care; however, further device refinement is needed to reduce technical failure.