Endolumenal Vacuum Therapy and Fistulojejunostomy in the Management of Sleeve Gastrectomy Staple Line Leaks

Abstract

Laparoscopic sleeve gastrectomy (LSG) is the most common bariatric surgery performed for morbid obesity. Leaks of the vertical staple line can occur in up to 7% of cases and are difficult to manage. Endolumenal vacuum (EVAC) therapy and fistulojejunostomy (FJ) have separate documented uses to heal these complicated leaks. We aim to show the benefit of using EVAC with FJ in the treatment of LSG staple line leaks. The patient presented with an LSG chronic leak. EVAC therapy was initiated but failed to close the fistula after 101 days. EVAC therapy was abandoned, and FJ was performed to resolve the leak. Postoperatively, no leak was encountered requiring any additional procedures. Based on our findings, we conclude that EVAC therapy facilitates in resolving leaks that restore gastrointestinal continuity and maintain source control. It promotes healing and causes reperfusion of ischemic tissue and fistula cavity debridement.

Endoscopic Stent Placement Can Successfully Treat Gastric Leak Following Laparoscopic Sleeve Gastrectomy If and Only If an Esophagoduodenal Megastent Is Used

“…Endoluminal vacuum therapy has recently been proposed as alternative treatment option for GL [ 44 , 45 ], primarily based on its efficacy in the management of anastomotic leaks following esophageal surgery. However, the evidence for the use of E-Vac in the specific management of sleeve GL remains the majority of the data supporting E-Vac therapy derives from studies in heterogenous patient cohorts, for a range of conditions [ 44 – 53 ]. In our hands, the results of EVac therapy for GL have been disappointing.…”

Safety and effectiveness of endoluminal vacuum-assisted closure for esophageal defects: Systematic review and meta-analysis

“…EVAC consists of placement of a sponge in the defect cavity or the esophageal lumen via the endoscope and connection of it to a negative pressure continuous vacuum 9 . EVAC treats the defect via mechanisms of leak source control, granulation tissue formation, encouraging reperfusion, and debridement of necrotic tissue once sponges are removed or replaced 9 10 . Modified from skin wound vacuum therapy, EVAC was introduced a decade ago for lower rectal anastomosis leaks and recently has gained popularity as an alternative treatment for defects in the upper gastrointestinal tract 11 .…”

Gastrointestinal fistula endoscopic closure techniques

“…4 ) is an emerging, minimally invasive technique. The EVAC delivers negative pressure to the site to collapse the cavity and create a seal [ 60 ]. The device consists of a sponge and tube attached to external vacuum suction.…”