title: Surgical endoscopic vacuum therapy for anastomotic leakage and perforation of the upper gastrointestinal tract.
abstract: BACKGROUND
  Emergency operations for perforations and anastomotic leakage of the upper gastrointestinal tract are associated with a high overall morbidity and mortality rate. An endoscopic vacuum therapy (EVT) has been established successfully for anastomotic leakage after rectal resection but only limited data exist for EVT of the upper GI tract.
  
  
  METHODS
  We report on a series of nine patients treated with EVT for defects of the upper intestinal tract between March 2011 and May 2012. In four patients, initial endoscopic sponge placement was performed in combination with open surgical revision. Median follow-up was 189 (range, 51-366) days.
  
  
  RESULTS
  In total, 52 vacuum sponges were placed in upper GI defects of nine patients. Indication for EVT were anastomotic leakage after esophageal resection or gastrectomy (n = 5) and iatrogenic or spontaneous esophageal perforations (n = 4). The mean number of sponge insertions was six (range, 1-13) with a mean changing interval of 3.5 days (range, 2-5). A successful vacuum therapy for upper intestinal defects was achieved in eight of nine patients (89 %).
  
  
  CONCLUSIONS
  EVT is a promising approach for postoperative, iatrogenic, or spontaneous lesions of the upper GI tract. If necessary the endoscopic procedure can be combined with operative revision for better control of the local septic focus.
authors.affiliation: Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057 Rostock, Germany. florian.kuehn@med.uni-rostock.de
authors.forename: F
authors.initials: F
authors.lastname: Kuehn
authors.forename: L
authors.initials: L
authors.lastname: Schiffmann
authors.forename: B M
authors.initials: BM
authors.lastname: Rau
authors.forename: E
authors.initials: E
authors.lastname: Klar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004939:Esophageal Perforation / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014618:Vacuum