Endoskopische Vakuumtherapie der Anastomoseninsuffizienz – Schritt für Schritt

Kantowski, Marcus; Karstens, Karl-Frederick

doi:10.1055/a-1369-5222

Cited by 2 publications

(3 citation statements)

References 31 publications

(17 reference statements)

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“…The system is well established in other wounds and the dressing material can easily be adapted for intrathoracic use. In addition to the well-known black vacuum sponges, several materials such as open pore film and small pore sponges (white sponge) were developed to tailor an optimal therapy for every purpose and to influence the ingrowth rate of the material and the changing interval (35,36). The open pore film can be easily placed in a small room such as the thoracic cavity and to wrap the lung to affect a granulation stimulus on the complete empyema cavity.…”

Section: Discussionmentioning

confidence: 99%

Intrathoracic vacuum therapy for the therapy of pleural empyema—a systematic review and analysis of the literature

Stüben¹,

Plitzko²,

Reeh³

et al. 2023

J Thorac Dis

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Background: Pleural empyema is a serious and potentially deadly disease leading to a significant burden on health care systems. Conservative and surgical treatment results remain poor, with high morbidity and mortality rates. Patients with pleural empyema are often multimorbid and poor candidates for surgery.Therefore, it appears sensible to explore alternative, less invasive treatment options. Recently, the wellestablished vacuum sponge therapy has been adopted in the treatment of pleural infections. The goal of this systematic review was to identify the existing literature and reported results of vacuum therapy for pleural empyema.Methods: A systematic search of MEDLINE and the Cochrane Database was performed independently by two reviewers using predefined criteria according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. In addition, abstracts from selected conference proceedings were screened and reference scanning of the search results was performed. Single case reports were excluded.Results: Fourteen studies met the selection criteria and were reviewed. A total of 165 patients were treated with vacuum therapy in the studies reviewed. 61.2% of the patients had pleural empyema secondary to thoracic surgery. In 71.5% of the patients, vacuum therapy was applied following open window thoracostomy (OWT). Mortality rates of 0-33% were reported for vacuum therapy after OWT and 0-9.3% for vacuum therapy without OWT. Length of hospital stay (LOHS) ranged from 44-217 days for patients after OWT and could not be analysed for vacuum therapy without OWT due to lacking data. Median treatment time was 7-14 days. Treatment related complications were rare overall. Success rates defined as infection resolution were high irrespective of previous treatment and cause of empyema. Conclusions:The current literature shows that pleural vacuum therapy is a promising, safe, and feasible treatment alternative to existing treatment modalities for pleural empyema. However, the evidence for vacuum therapy without OWT is poor, and further data, optimally prospective or randomised control trials comparing the conventional surgical approach of video-assisted thoracoscopic surgery (VATS) decortication and minimally invasive vacuum therapy, are needed.

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Section: Discussionmentioning

confidence: 99%

Intrathoracic vacuum therapy for the therapy of pleural empyema—a systematic review and analysis of the literature

Stüben¹,

Plitzko²,

Reeh³

et al. 2023

J Thorac Dis

View full text Add to dashboard Cite

show abstract

“…Several materials, such as open pore films and small pore sponges, have been developed to tailor optimal therapy for a variety of purposes. Open pore film drainage has been used either extraluminal for small gastrointestinal leaks or intraluminal and can be easily placed in the thoracic cavity to ensure adequate cleaning and granulation of the empyema cavity 19 , 27 .…”

Section: Discussionmentioning

confidence: 99%

“…In contrast to conventional VATS with a rigid and straight fiberoptic, where access to the often small and winding parts of the empyema via the drainage channel is not possible without opening the complete pleural cavity, with flexible endoscopy a tool exists with which it is possible to reach all areas of the empyema cavity. This technique has already been validated for the management of anastomotic leakages after gastrointestinal surgery 17 – 19 .…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive intrathoracic negative-pressure therapy and flexible thoracoscopy (FlexVATS) for patients with pleural empyema

Stüben

Plitzko

Sauerbeck

et al. 2023

Sci Rep

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To determine whether a new surgical method using a flexible endoscope (FlexVATS) to perform sparing debridement and apply negative-pressure therapy without extensive decortication may be an alternative treatment option for empyema. Surgical treatment of pleural empyema is associated with considerable postoperative complications and mortality rates, and alternative treatment options are being explored to improve patient outcomes. This was a prospective case series. Seventeen consecutive patients treated with FlexVATS between February 2021 and August 2022 were included in the study. Only patients for whom FlexVATS was the first therapeutic intervention for pleural empyema were included. Treatment success, defined as infection resolution, was the primary endpoint of the study. The secondary endpoints were length of hospital stay, 90-day mortality, and empyema cavity volume reduction. Patients who had previously been treated for pleural empyema by either drainage or surgery were excluded. The trial was performed as a single-centre study at a tertiary medical centre in Germany. In total, 17 patients with pleural empyema were included in the study. The median (IQR) duration of vacuum treatment was 15 days (8–35 days). Twelve of the 17 (71%) patients were successfully treated, and a significant reduction in the empyema cavity volume was observed. 41% of the dressing changes were performed outside the operating room. Compared with a historic cohort of conventionally treated patients (decortication via VATS or thoracotomy), the 90-day mortality rates tended to be lower without reaching statistical significance. Three patients (18%) died in hospital during treatment. No negative pressure-therapy-related complications were observed. FlexVATS therapy is a promising alternative therapy for both healthy and debilitated patients with pleural empyema. Larger randomised trials are required to validate this treatment option.

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Endoskopische Vakuumtherapie der Anastomoseninsuffizienz – Schritt für Schritt

Cited by 2 publications

References 31 publications

Intrathoracic vacuum therapy for the therapy of pleural empyema—a systematic review and analysis of the literature

Intrathoracic vacuum therapy for the therapy of pleural empyema—a systematic review and analysis of the literature

Minimally invasive intrathoracic negative-pressure therapy and flexible thoracoscopy (FlexVATS) for patients with pleural empyema

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