Effective use of the endoscopic vacuum system in the comprehensive treatment of a patient with a defect in the abdominal segment of the esophagus after gastrectomy

• Main Authors: Omar B Abu-Khaidar, Aleksandr S Vodoleev, Sergei S Pirogov, Vladimir M Khomiakov, Andrei B Riabov
• Format: Article
• Language: Russian
• Published: IP Habib O.N. 2019-06-01
• Series: Современная онкология
• Subjects: anastomotic leak; endoscopic vacuum treatment; defects of the abdominal segment of the esophagus
• Online Access: https://modernonco.orscience.ru/1815-1434/article/viewFile/33525/pdf
• ISSN: 1815-1434; 1815-1442

In oncosurgery esophago-intestinal anastomotic leak as well as defects of the abdominal segment of the esophagus are serious complications associated with prolonged hospital stay and increased mortality rate. A choice of management tactics for each patient is individual. Treatment of esophageal anastomotic leak without separation provides the best result by reducing the time of rehabilitation, improving the quality of life and reducing mortality. Conservative treatment requires an adequate drainage when conducting enteral feeding and adequate antibiotic therapy. The indications for separation of the anastomosis include a large defect size, necrosis of the graft uncontrolled purulent-septic complications and a failure of conservative therapy. In recent decades a number of methods for endoscopic treatment of anastomotic leaks in the gastrointestinal tract have been elaborated, including the use of adhesive agents, self-expanding stents, clipping, and endoscopic vacuum system. These methods have several advantages over surgical and conservative management. Despite the accumulated experience, at present there is no single systemic approach to the use of endoscopic methods for closure of defects of anastomosis as well as defects of the abdominal segment of the esophagus. This is mainly due to a relatively small number of publications. One of the promising methods for endoscopic treatment of anastomotic leak is currently the Endoscopic Vacuum System (EndoVAC therapy). The article provides the clinical case of a patient with stomach cancer who was given transperitoneal gastrectomy with D2-lymphadenectomy which was complicated by a defect in the abdominal segment of the esophagus with peritonitis. To treat those complications relaparotomy, sanitation and drainage of the abdominal cavity was performed. In order to achieve closure of the fistula more quickly the vacuum system was used resulting in a marked decrease in fluid exudation, which in turn contributed to closure of the fistula.