PS01.083: NEGATIVE INTRALUMINAL PRESSURE FOR COMPLEX ESOPHAGEAL PERFORATIONS OR ANASTOMOTIC LEAKS

Abstract

Abstract Background Dehiscence of esophago-gastric or esophago-jejunal anastomosis and spontaneous esophageal perforation are life threatening conditions due to the likelihood of breakdown following repair and the sequelae of sepsis. No unit has a large experience in the management of these problems and many approaches are described. Negative intraluminal pressure therapy (NIPT) is a method of minimally invasive operative management described by Berrisford and colleagues (Eur J Cardio-Thoracic Surg 33;2008;742–744). Despite its success, few institutions have reported on its use. Methods We reviewed our experience with the management of complex esophageal and anastomotic leaks and identified those that failed stenting, or where the diagnosis of major clinical anastomotic leaks was delayed. In this unit NIPT is the treatment of choice for these at risk patients. NIPT involves the open or endoscopic placement of an intra-luminal drainage tube with multiple side-holes, which is placed across the esophageal defect and brought through the stomach or jejunum and through the upper abdominal wall. A 10cm negative pressure of H20 is applied and the patency of the tube is maintained by the patient orally ingesting sterile water continuously. Nutrition may be provided parenterally or jejunally. Results Eleven patients were identified who were treated with NIPT for either esophageal perforation or delayed anastomotic failure over a 7 year period. Four patients had anastomotic leaks, 4 had iatrogenic perforations (2 failed stenting and 1 delayed diagnosis) and 3 had Boerhaave's syndrome. Of the 11 patients, 8 were male. Age ranged from 19–71 years. The median duration of drain application was 19 days. For 5 of the 11 patients, NIPT was combined with some degree of formal operative intervention. Operative video footage was taken and archived where possible. Complete restoration of the GI tract continuity was achieved in all patients. There was no significant procedural morbidity and there were no mortalities. Conclusion NIPT is a minimally invasive treatment option for complex esophageal/anastomotic leaks and we advocate its use, alone or as an adjunct to surgical intervention, in the above patient cohort. We have increasingly inserted the tube successfully under sedation alone, reducing the perioperative complications of general anaesthesia. Disclosure All authors have declared no conflicts of interest.