Endoscopic vacuum therapy for anastomotic leakage after upper gastrointestinal surgery
Gunnar Loske
Abstract
Endoscopic vacuum therapy (EVT) is a highly effective treatment option for leaks throughout the gastrointestinal (GI) tract and is an extremely beneficial technique in visceral surgery.It represents one of the most important innovations in the management of endoscopic surgical complications in the last 20 years [1,2].For the management of complications in esophageal surgery, a distinction can be drawn between the pre-and post-EVT eras [3].The technique is increasingly being used not only for therapeutic purposes but also for pre-emptive prophylaxis with the aim of protecting intraoperative anastomoses [4].Many centers, including that of Pattynama et al. in Amsterdam, now regard EVT as the gold-standard treatment for anastomotic leaks following upper GI (UGI) tract surgery [5].The innovative treatment approach is attracting a particularly high level of interest for anastomotic insufficiency following esophagectomy, which still has a high incidence.Because of the intrathoracic site of the anastomosis, patients are at critical risk not only of local infection but also of septic mediastinitis, which carries high morbidity and mortality.EVT differs from all of the previously known endoscopic methods in some fundamental respects.It is a surgical wound