Abstract
BackgroundTreatment 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 presentationA 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.ConclusionOur experience shows the usefulness of E-Vac therapy in the management of anastomotic and non-anastomotic esophageal fistulas. Further research is needed to better define its indications, to compare it to traditional treatments and to evaluate its long-term efficacy.
Highlights
Treatment of esophageal perforations and postoperative anastomotic leaks of the upper gastrointestinal tract remains a challenge
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]
This paper reports the successful closure of two different kinds of esophageal fistula; the first one is a complex anastomotic leak, complicated by pleuro-mediastinal abscess, after esophagectomy for cancer, which is the most common indication for this treatment
Summary
Our cases confirm that the open-cell sponge together with the topical application of negative pressure helps sealing the leak while providing an additional and simultaneous drainage of the cavity distal to it. This transluminal drainage allows an effective and continuous drainage of the abscess cavity, which is often difficult to address radiologically, controlling and reducing the sepsis. Both our cases, despite different pathologies and type of perforations, were successfully treated with the EVAC therapy, confirming its promising prospects for all Competing interests The authors declare that they have no competing interests. Author details 1General Surgery III, ASST Papa Giovanni XXIII, Bergamo, Italy. 2General Surgery I, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127 Bergamo, Italy. 3Department of Gastroenterology and Endoscopy, ASST Papa Giovanni XXIII, Bergamo, Italy
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