Endoluminal Wound Vacuum-Assisted Closure: Bridging the Gap

Abstract

INTRODUCTION: Endoluminal vacuum therapy (EVAC) is used to divert gastrointestinal contents and aid closure of esophageal, gastric, and colonic perforation. Recent publications demonstrate a high success rate in defect closure and avoidance of high-risk, salvage operation. We describe our experience with EVAC at 2 tertiary care centers. METHODS: Retrospective review of prospectively maintained database of patients undergoing EVAC therapy from 2018 to 2022. Baseline demographics were recorded, as well as primary operation, severity of illness, indication for therapy, duration of EVAC, and overall success in defect closure. RESULTS: Thirteen patients underwent EVAC therapy, the average age was 52 years, and 12 (92%) were men. Eight (62%) patients underwent EVAC therapy for an upper gastrointestinal tract perforation/leak and 5 (38%) for a lower gastrointestinal tract defect. EVAC therapy in 12 (92%) led to healing of the defect and full closure in 9 (69%) with EVAC alone. One (8%) patient was transitioned to comfort care and died while undergoing EVAC therapy. Four (31%) patients were critically ill at time of placement with a Sequential Organ Failure Assessment score of 5.5 (range 3 to 9). EVAC therapy required an average 16.7 (range 4 to 41) days with 3 (range 0 to 7) exchanges. Three (23%) were successfully managed on the floor and 1 (8%) as an outpatient. CONCLUSION: EVAC therapy is a versatile technique that can safely and effectively manage complicated injury throughout the gastrointestinal tract, replacing some high-risk surgical salvage procedures. EVAC therapy has a high success rate in appropriately selected patients with limited gastrointestinal tract defects.