Endoscopic Vacuum Therapy (EVT) for Persistent Duodenal Stump Dehiscence After Upper Gastrointestinal Surgery in Selected Patients: A Tertiary Referral Center Case Series. Issue 4 (August 2021)

• Record Type: Journal Article
• Authors: Mutignani, Massimiliano; Dioscoridi, Lorenzo; Massad, Mutaz; Bonato, Giulia; Pugliese, Francesco; Cintolo, Marcello; Forti, Edoardo
• Is Part Of: Surgical laparoscopy endoscopy & percutaneous techniques. Volume 31:Issue 4(2021)
• Publication Date: 2021-08
• Subjects: endoscopic vacuum therapy -- postoperative adverse event -- surgically altered anatomy; Endoscopic surgery -- Periodicals; Laparoscopic surgery -- Periodicals; Endoscopy -- Periodicals; Laparoscopy -- Periodicals; 617.550597
• DOI: 10.1097/SLE.0000000000000912
• Languages: English
• ISSNs: 1530-4515

Abstract

Abstract : Introduction: The usefulness of endoscopic vacuum therapy (EVT) in the setting of postoperative gastrointestinal leaks is widely described. On this basis, we would like to focus a specific application of EVT: the dehiscence of the duodenal stump after upper gastrointestinal surgery. Standard EVT is not applicable in these cases because of technical limitations (length of overtube and devices). However, vacuum stimulates the healing of leaks and fistulas through granulation tissue's formation and would be effective also in this setting. Materials and Methods: Between October 2019 and January 2020, 7 consecutive patients (4 M, 3 F, 62±9 y old) affected by duodenal stump's dehiscence were endoscopically treated by the placement of a large-bore (14 to 18 Ch) suction tube across the wall's defect into the peritoneal cavity. Continuous aspiration at −80/−100 mm Hg was applied. Clinical success was established both by fluoroscopic check injecting contrast medium from the tube to verify the fistula's closure and by abdominal computed tomography scan to exclude residual fluid collections. Results: Technical and clinical success were achieved in all the patients. The suction tube was maintained in site for 12±5 days in continuous aspiration. The drainage's output became null in 2±1 days without any intra-abdominal residual fluid collection. The principle of this technique is to let the duodenal walls' stump to collapse on the intraluminal part of the tube (with subsequent mucosal intussusception into the holes of the tube itself) creating a sort of vacuum-packed barrier to interrupt the outflow of enteric materials into the fistula's path. It guarantees the fistula's closure by the gradual formation of granulation tissue. Conclusions: The present technique offers a safe and viable endoscopic alternative to treat duodenal stump's leaks after upper gastrointestinal surgery.