Endoscopic vacuum-assisted closure system (E-VAC): case report and review of the literature

Abstract

Negative pressure wound therapy (NPWT) has become a standard in the treatment of chronic and difficult healing wounds. Negative pressure wound therapy is applied to the wound via a special vacuum-sealed sponge. Nowadays, the endoscopic vacuum-assisted wound closure system (E-VAC) has been proven to be an important alternative in patients with upper and lower intestinal leakage not responding to standard endoscopic and/or surgical treatment procedures. Endoscopic vacuum-assisted wound closure system provides perfect wound drainage and closure of various kinds of defect and promotes tissue granulation. Our experience has shown that E-VAC may significantly improve the morbidity and mortality rate. Moreover, E-VAC may be useful in a multidisciplinary approach - from upper gastrointestinal to rectal surgery complications. On the other hand, major limitations of the E-VAC system are the necessity of repeated endoscopic interventions and constant presence of well-trained staff. Further, large-cohort studies need to be performed to establish the applicability and effectiveness of E-VAC before routine widespread use can be recommended.

Keywords: Endo-Sponge; endoscopic vacuum-assisted wound closure system; eosophageal leakage; pancreatico-gastric anastomotic insufficiency; rectal anastomotic leakage; vacuum-assisted wound closure therapy.

Photo 1

Details of endoscopic vacuum therapy in a patient after a leakage of the gastro-pancreatic anastomosis (leak highlighted in red, pancreas marked with [3]). The nasogastric tube with black sponge [1] is introduced to the stomach endoscopically, using suture [5], similar as in PEG technique. The suture has been previously attached to the drain, which was removed endoscopically through the stomach and esophagus. Abdominal wall opening after the drain is marked with [4], drain localized close to the anastomotic leakage is marked with [2]

Photo 2

Nasogastric tube is connected with black sponge. The form and size of the sponge is similar to the size and form of the anastomotic leakage. Sponge is stabilized with suture to avoid the tube falling out and leakage being left in. Then the suture introduced by the place after the drain is stabilized to the sponge

Photo 3

Endoscopic view of tube application – carried through the stomach using forceps

Photo 4

Endoscopic view of the last stage of the procedure – nasogastric tube with the sponge introduced into the leakage, good stabilization of the position possible by the suture derived through the abdominal wall