Anastomotic leak or intestinal perforation remains a major complication of surgery of the gastrointestinal tract and usually requires operative intervention. Complex management pathways for iatrogenic or failed anastomosis of the gastrointestinal tract, which are innovative and less invasive, need to be tested and implemented. The use of endoluminal vacuum (E-Vac) therapy accomplishes that goal. This technology uses negative pressure vacuum therapy through a natural orifice, such as the rectum or mouth, to control contamination through the intestinal opening and allows second-intention healing to perforations or leaks of the gastrointestinal tract. We are able to assemble the technology out of presently available wound care supplies used for traditional superficial wound closure modified for endoluminal placement. The technology entails delivery of a granulofoam endosponge secured to the tip of a well-tolerated, Silastic nasogastric tube that is placed at the site of gastrointestinal disruption after copious irrigation of the cavity. Negative pressure is applied to gain the desired effect similar to that observed for superficial wound management. This delivery is done endoscopically under general anesthesia, and the E-Vac materials are removed after the cavity has sealed (Figure). This article focuses on the use of E-Vac therapy for esophageal, gastric, and small intestine leaks or perforations.
Leeds SG, Burdick JS, Fleshman JW. Endoluminal Vacuum Therapy for Esophageal and Upper Intestinal Anastomotic Leaks. JAMA Surg. 2016;151(6):573-574. doi:10.1001/jamasurg.2016.0255