Anastomotic leakage after esophageal resection: new treatment options by endoluminal vacuum therapy.
BACKGROUND
Anastomotic leakage after esophagectomy is an important determinant of early and late morbidity and mortality. Control of the septic focus is essential when treating patients with anastomotic leakages. Surgical and endoscopic treatment options are limited.


METHODS
Between 2005 and 2009, we treated 6 patients who experienced an intrathoracic anastomotic leakage after esophageal resection. After all established therapeutic measures had failed, we explored the feasibility of an endoscopically assisted mediastinal vacuum therapy.


RESULTS
We were able to heal intrathoracic esophageal leakages in all 6 patients without any local complications and without the need for reoperation. One patient died because of a progressive pneumonia.


CONCLUSIONS
Endoscopic vacuum-assisted closure of anastomotic leakages may help to overcome the limitations that are associated with intermittent endoscopic treatment and conventional drainage therapy. Our preliminary results suggest that this new concept may be suitable for those patients.
Department of Surgery, University Hospital Campus Grosshadern, Ludwig-Maximilian-University of Munich, Munich, Germany. rolf.weidenhagen@med.uni-muenchen.de
Rolf
R
Weidenhagen
Wolfgang H
WH
Hartl
Klaus U
KU
Gruetzner
Martin E
ME
Eichhorn
Fritz
F
Spelsberg
Karl W
KW
Jauch
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D004322:Drainage; D004724:Endoscopy; D016629:Esophagectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D015607:Stents