title: Endoluminal vacuum therapy for gastrojejunal anastomotic leaks after Roux-en-Y gastric bypass: a pilot study in a swine model.
abstract: Roux-en-Y gastric bypass (RYGB) consistently produces the most sustainable weight loss among common interventions for morbid obesity. Anastomotic leaks at the gastrojejunal (GJ) connection result in severe morbidity. We apply endoluminal negative pressure vacuum devices (EVD) to heal anastomotic leaks in a swine model.
  
  
  
  RYGB was performed in 10 pigs (3 control, 7 experimental). GJ anastomoses were fashioned, and a 2-cm defect was made across the staple line. In controls, the defects remained open. In experimental pigs, the EVD was placed across the defect and kept at continuous 50 mmHg suction. All pigs were euthanized on postoperative day seven unless they displayed signs of peritonitis or sepsis. Fluoroscopy and necropsy were performed to assess a persistent leak, and tissue specimens were sent to histology to evaluate for degree of inflammation and ischemia.
  
  
  
  All three control pigs' GJ anastomoses demonstrated evidence of a persistent leak. All seven experimental pigs with the EVD in place showed evidence that their leak had sealed at time of fluoroscopy (p value 0.008).
  
  
  
  Endoluminal vacuum therapy is well tolerated in a swine model. GJ anastomotic leaks were consistently sealed with our device in place compared to controls. This therapy shows promise as a method to address GJ leaks in the bariatric population, and thus, we believe additional evaluation is warranted.
authors.affiliation: Department of Surgery, Western Connecticut Health System, 24 Hospital Avenue, Danbury, CT, 06810, USA. rachel.scott@wchn.org.
authors.forename: Rachel B
authors.identifier: 0000-0002-8655-6901
authors.initials: RB
authors.lastname: Scott
authors.affiliation: Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: Lane A
authors.initials: LA
authors.lastname: Ritter
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Amber L
authors.initials: AL
authors.lastname: Shada
authors.affiliation: Center for Comparative Medicine, University of Virginia, Charlottesville, VA, USA.
authors.forename: Sanford H
authors.initials: SH
authors.lastname: Feldman
authors.affiliation: Department of Surgery, Western Connecticut Health System, 24 Hospital Avenue, Danbury, CT, 06810, USA.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Kleiner
mesh_terms: D057868:Anastomotic Leak / Q000209:etiology* / Q000628:therapy*; D000818:Animals; D015390:Gastric Bypass / Q000009:adverse effects*; D023421:Models, Animal; D054843:Negative-Pressure Wound Therapy; D010865:Pilot Projects; D013552:Swine
keywords: Anastomotic leak; Endoluminal vacuum therapy; Gastric bypass; Morbid obesity; Swine