ENDOSCOPIC VACUUM-ASSISTED CLOSURE (E-VAC) IN ACUTE MEDIASTINITIS FROM ANASTOMOTIC LEAKAGE AFTER INTRATHORACIC ESOPHAGEAL JEJUNAL ANASTOMOSIS
Our aim was to assess the role of negative pressure therapy in the treatment of anastomotic leakage, after intrathoracic esophageal jejunal anastomosis by the evaluation of the time required for healing and the functional outcomes of patients. We present the case of a 73 years old male patient admitted in our clinic with esophageal perforation that appeared possible after a left thoracotomy necessary for an intrathoracic esophageal jejunal Roux-en-Y procedure, after a total gastrectomy for gastric neoplasm. There are groups that propose different approaches such as surgery variations or combinations of the surgery with or without adjuvant treatments, as the use of a hyperbaric chamber or vacuum devices such as Endoscopic Vacuum-Assisted Closure (E-VAC). Using a modified double-lumen naso-gastric probe adapted to the negative pressure unit and using the same principle as in the negative pressure treatment of soft tissue wounds we have achieved positive results with successful cure of esophageal perforation. The toraco-abdominal computed tomography done with contrast substance confirmed the esophageal perforation. The patient had a full recovery after 19 days of hospitalization with a positive check-up at one and two months after leaving our clinic. After the basic wound treatment, auxiliary methods such as negative pressure contributed to healing. Endoscopic vacuum treatment for parietal lesions of the esophageal wall is a great procedure in the management of this pathology with a high mortality and the surgeons and gastroenterologist must have considered as a treatment option in this kind of lessons. The prospective and comparative studies are necessary for the evaluation of this new and minim invasive procedure.
2. Marcelo C.F, Alves Das Neves-Junior M, Cunha De Santana T. Acute Mediastinitis. Retrospectives Analyses of 21 Cases. J Bras Pneumol 2005; 31(4): 307-311.
3. Mueller D, Mancini MC. Mediastinitis. Medscape. Feb 12, 2018.
4. Søreide JA, Viste A. Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2011; 19: 66.
5. Eroğlu A, Aydın Y, Yılmaz O. Minimally invasive management of esophageal perforation. Turkish Journal of Thoracic and Cardiovascular Surgery 2018; 26(3): 496-503;
6. Wei D, Bi L, Zhu H, He J, Wang H. Less invasive management of deep neck infection and descending necrotizing mediastinitis A single-center retrospective study. Medicine 2017; 96: 15.
7. Pines G, Bar I, Elami A, Sapojnikov S, et al. Modified Endoscopic Vacuum Therapy for Nonhealing Esophageal Anastomotic Leak: Technique Description and Review of Literature .Journal of Laparo-endoscopic & Advanced Surgical Techniques 2018; 28: 1.
8. Manfredi MA, Clark SJ, Staffa SJ, Ngo PD, et al. Endoscopic Esophageal Vacuum Therapy: A Novel Therapy for Esophageal Perforations in Pediatric Patients Michael.J Pediatr Gastroenterol Nutr 2018; 67(6): 706-712.
9. Möschler O, Nies C, Mueller MK. Endoscopic vacuum therapy for esophageal perforations and leakages. Endosc Int Open 2015; 3(6): E554-E558;
10. Laukoetter MG, Mennigen R, Neumann PA, Dhayat S, Horst G, Palmes D, et al. Successful closure of defects in the upper gastrointestinal tract by endoscopic vacuum therapy (EVT): a prospective cohort study. Surg Endosc 2017; 31: 2687-2696;
11. Ciobica A, Padurariu M, Ciobica Al, et al. General issues encountered while diagnosing mild cognitive impairment in Romanian patients. International Journal of Geriatric Psychiatry 2017; 32(1): 116-117.
12. Ochiuz L, Grigoras C, Popa M, et al. Alendronate-Loaded Modified Drug Delivery Lipid Particles Intended for Improved Oral and Topical Administration. Molecules 2016; 21(7): 858.
13. Arcan O, Bild W, Ciobica A, et al. Angiotensin-(1-7) intracerebroventricular administration generates nociceptive effects in hot-plate task and decreased oxidative stress in the temporal lobe Romanian Bi-otechnological Letters 2014, 19(5): 9763-9771.
14. Gradinaru I, Timofte D, Vasincu D, et al. Preliminary Results on Pulsed Laser Deposition of PMMA on Nitinol Substrate Materiale Plastice 2014; 51(3): 230-234.
15. Anton E, Rotaru A, Covatariu D, et al. Links between extremely high frequency electromagnetic waves and their biological manifestations. Archives of Biological Sciences Belgr 2015; 67(3): 895-897.
16. Lyman D. Spontaneous Esophageal Perforation in a Patient with Mixed Connective Tissue Dis-ease. The Open Rheumatology Journal. 2011; 5: 138-143.
17. Brangewitz M, Voigtländer T, Helfritz FA, Lankisch TO, Winkler M, Klempnauer J, et al. Endoscopic closure of esophageal intrathoracic leaks: stent versus endoscopic vacuum-assisted closure, a retro-spective analysis. Endoscopy 2013; 45: 433-438.
18. Hwang JJ, MD, Jeong YS, Park YS, Yoon H, Shin CM, et al. Comparison of Endoscopic Vacuum Therapy and Endoscopic Stent Implantation With Self-Expandable Metal Stent in Treating Postsurgical Gastroesophageal Leakage. Medicine (Baltimore) 2016; 95(16): e3416.
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