Endoluminal Vacuum Therapy for Ivor Lewis Anastomotic Leaks: A Pilot Study in a Swine Model

Rd, Scott; Ritter, LA; Shada, AL; Feldman, Steven R.; Kleiner, Daniel

doi:10.1111/cts.12427

Cited by 13 publications

(13 citation statements)

References 14 publications

(24 reference statements)

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“…In a recent case series, early EVT in patients with anastomotic ischemia was effective in six of eight esophagectomy patients [ 98 ]. Likewise, in a porcine model, intraoperative application of EVT in esophagogastric anastomoses with intentional 1 cm defects resulted in complete healing [ 99 ]. Considering the high incidence of AL, we have recently implemented preemptive EVT (pEVT) in patients undergoing esophagectomy and gastric tube reconstruction.…”

Section: Surgical-technical Aspectsmentioning

confidence: 99%

Strategies to prevent anastomotic leakage after esophagectomy and gastric conduit reconstruction

Vetter

Gutschow

2020

Langenbecks Arch Surg

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Background Surgery remains the cornerstone of esophageal cancer treatment but is burdened with high procedure-related morbidity. Anastomotic leakage as the most important surgical complication after esophagectomy is a key indicator for quality in surgical outcome research. Purpose The aim of this narrative review is to assess and summarize the current knowledge on prevention of anastomotic leakage after esophagectomy and to provide orientation for the reader in this challenging field of surgery. Conclusions There are various strategies to reduce postoperative morbidity and to prevent anastomotic leakage after esophagectomy, including adequate patient selection and preparation, and many technical-surgical and anesthesiological details. The scientific evidence regarding those strategies is highly heterogeneous, ranging from expert’s recommendations to randomized controlled trials. This review is intended to serve as an empirical guideline to improve the clinical management of patients undergoing esophagectomy with a special focus on anastomotic leakage prevention.

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Section: Surgical-technical Aspectsmentioning

confidence: 99%

Strategies to prevent anastomotic leakage after esophagectomy and gastric conduit reconstruction

Vetter

Gutschow

2020

Langenbecks Arch Surg

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“…In contrast, no leaks were detected in the ENP cohort after 3–7 days follow-up (p = 0.03). This study demonstrated that pENP may have the potential to close leaks that otherwise would persist without surgical or endoscopic intervention [ 26 ]. Further evidence supporting this hypothesis stems from our own Institution’s retrospective case-series of 20 consecutive patients undergoing minimally invasive oesophagectomy with pENP, anastomotic healing was uneventful in 19/20 anastomoses resulting in an AL rate of 5%.…”

Section: Discussionmentioning

confidence: 99%

Pre-Emptive Endoluminal Negative Pressure Therapy at the Anastomotic Site in Minimally Invasive Transthoracic Esophagectomy (the preSPONGE Trial): Study Protocol for a Multicenter Randomized Controlled Trial

Müller

Vetter

Kapp

et al. 2021

International Journal of Surgery Protocols

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Introduction: Anastomotic leakage (AL) accounts for a significant proportion of morbidity following oesophagectomy. Endoluminal negative pressure (ENP) therapy via a specifically designed polyurethane foam (EsoSponge ® , B.Braun Medical, Melsungen, Germany) has become the standard of care for AL in many specialized centres. The prophylactic (pENP) application of this technique aims to reduce postoperative morbidity and is a novel approach which has not yet been investigated in a prospective study. The aim of this study is therefore to assess the effect of pENP at the anastomotic site in high-risk patients undergoing minimally invasive transthoracic Ivor Lewis oesophagectomy. Methods and analysis: The study design is a prospective, multi-centre, two-arm, parallel-group, randomised controlled trial and will be conducted in two phases. Phase one is a randomised feasibility and safety pilot trial involving 40 consecutive patients. After definitive sample size calculation, additional patients will be included accordingly during phase two. The primary outcome of the study will be the postoperative length of hospitalization until reaching previously defined “fit for discharge criteria”. Secondary outcomes will include postoperative morbidity, mortality and postoperative AL-rates based on 90-day follow-up. A confirmatory analysis based on intention-to-treat will be performed. Ethics and dissemination: The ethics committee of the University of Zurich approved this study (2019-00562), which has been registered with ClinicalTrials.gov on 14.11.2019 (NCT04162860) and the Swiss National Clinical Trials Portal (SNCTP000003524). The results of the study will be published and presented at appropriate conferences.

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“…EVT has even been noted to work as well as stents or seen to be superior to stent placement (20,21,37). It has also been shown to function as a bridge to other modalities such as surgery (53). The most severe complication published from EVT usage is bleeding, though rare overall (43).…”

Section: Discussionmentioning

confidence: 99%

Endoluminal wound vac: an evolving role in treatment of esophageal perforation

Moore¹,

Almoghrabi²,

Hofstetter³

et al. 2020

J Vis Surg

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Treatment options of esophageal perforation/ leaksEsophageal leaks and perforations span a spectrum of severity. Whether benign or malignant, leaks and perforations are caused by a transmural disruption of the esophagus (1). Most esophageal perforations are iatrogenic and occur during diagnostic and endoscopic procedures (2). Boerhaave syndrome represents a perforation caused by an abrupt increase in the esophageal pressure following emesis in the absence of relaxation of the superior esophageal sphincter (3-5). It was first described by the Dutch physician Herman Boerhaave. Boerhaave presented the autopsy findings of Baron von Wassenaer, Grand Admiral of the Fleet of Holland (6,7). von Wassenaer presented to Boerhaave after a night of overeating, several episodes of emesis, and chest pain. In Boerhaave's report, he described classic features noted in esophageal perforations including mediastinal emphysema and contamination of the pleural fluid (6,7).Leaks and perforations can be diagnosed by chest X-ray (CXR). However, the gold standard study remains contrast esophagram using a water-soluble medium that may have to be followed by a barium study if the initial result is negative.If there is an issue with performing an esophagram, the alternative is a contrast-enhanced computed tomography (CT) scan (8,9). Signs of perforation and leaks include mediastinal air, extravasated luminal contrast, periesophageal fluid collections, and pleural effusions (8,9). An endoscopic procedure is also recommended for confirmatory diagnosis as well as diagnostic decision making (8,9). The treatment options for esophageal leaks and perforations are associated with considerable morbidity and mortality (10). Based on work dating back to 1936, Jemerin was the first to confirm that drainage surgery should be the standard for leaks and perforations. Studies before this time showed that no surgical treatment would lead to significant death in twenty-four hours (11). Most of these drainage procedures occurred in the neck, and perforations were due to iatrogenic causes. Collis, in 1944, was the first to perform a thoracotomy for rupture (12,13). Barrett, Olsen, and Clagett presented other studies to confirm the importance

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Endoluminal Vacuum Therapy for Ivor Lewis Anastomotic Leaks: A Pilot Study in a Swine Model

Cited by 13 publications

References 14 publications

Strategies to prevent anastomotic leakage after esophagectomy and gastric conduit reconstruction

Strategies to prevent anastomotic leakage after esophagectomy and gastric conduit reconstruction

Pre-Emptive Endoluminal Negative Pressure Therapy at the Anastomotic Site in Minimally Invasive Transthoracic Esophagectomy (the preSPONGE Trial): Study Protocol for a Multicenter Randomized Controlled Trial

Endoluminal wound vac: an evolving role in treatment of esophageal perforation

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