Sasha Still, MD1, Marissa Mencio, MD1, Estrellita Ontiveros, MA1, James Burdick, MD2, Steven G Leeds, MD1. 1Division of Minimally Invasive Surgery, Baylor University Medical Center at Dallas, 2Department of Gastroenterology, Baylor University Medical Center at Dallas
Introduction: Esophageal perforation is a devastating event associated with high morbidity and mortality, yet optimal management remains controversial. Endoluminal wound vac (E-Vac) therapy has been shown to be a useful modality in the treatment of hollow viscus perforation.
Methods: An IRB approved registry for E-Vac patients was queried from July 2013 to September 2016. Out of 53 patients, 13 patients had esophageal perforations or leaks. E-Vac is a negative pressure internal wound vacuum device with an endosponge placed endoscopically into, or adjacent to, a hollow viscus leak site. Rescue therapy is defined as E-Vac therapy initiated following operative repair failure.
Results: Thirteen patients were treated for esophageal perforations (11 thoracic, 1 thoracoabdominal, 1 cervical). Etiologies included iatrogenic injury (8), anastomotic leak (2), Boerhaave syndrome (1), and bronchoenteric fistula (2). Ten patients (77%) underwent primary treatment with E-Vac and 3 (23%) were treated as rescue therapy. Mean Pittsburg Perforation Scores in the primary and salvage treatment groups were 7 and 10, respectively. Average defect size was 2.4 (range 0.5-6) cm. Mean time to E-Vac placement following operative management was 22 (range 20-25) days. The rescue group had a shorter mean time to defect closure (25 vs 33 days). One E-Vac related complication (sponge migration) occurred. There was one death attributed to respiratory compromise after the implementation of comfort care. Hospital length of stay was longer in the rescue group (72 vs 53), however ICU durations were similar (23 vs 22 days). Ten patients (83%) resumed an oral diet within one month of discharge.
Conclusion: Utilized as either a primary or rescue therapy, E-Vac therapy appears to be a beneficial treatment modality in the management of esophageal perforation or leak.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 84430
Program Number: ET003
Presentation Session: Emerging Technology Session
Presentation Type: Podium
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