Use Of Endoscopic Vacuum-assisted Closure For Anastomotic Dehiscence
Daniela Molena, Arianna Barbetta, MD, David R. Jones, MD.
Memorial Sloan Kettering Cancer Center, New York, NY, USA.
OBJECTIVE: Anastomotic leaks are dreaded complications after esophagectomy, associated with short and long-term poor outcomes. There is no agreement among expert about the best way to treat these complications. Recently endoscopic vacuum-assisted closure (EndoVAC) has been introduced with good results.
METHODS: In this video we describe how to prepare and position an EndoVAC.
RESULTS: The patient underwent chemoradiation followed by surgery for esophageal cancer. Post-operatively he developed a dehiscence at the lesser curvature of the stomach which was initially treated conservatively. The dehiscence extended to the anastomosis creating an esophago-gastric pleural fistula. The patient was taken back to the operating room for lung decortication and repair of the dehiscence with serratus muscle transposition flap. The fistula healed temporarily and the patient was restarted on an oral diet. Few weeks later the fistula reopened with drainage in the right chest. We used this technique as the last resort for this complicated patient.
CONCLUSIONS: EndoVAC is an innovative technique for treatment of complicated dehiscence and fistula after esophagectomy.
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