General Surgery III, ASST Papa Giovanni XXIII, Bergamo, Italy.
General Surgery I, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy.
World J Surg Oncol. 2020 Nov 14;18(1):301. doi: 10.1186/s12957-020-02073-6.
Treatment of esophageal perforations and postoperative anastomotic leaks of the upper gastrointestinal tract remains a challenge. Endoluminal vacuum-assisted closure (E-Vac) therapy has positively contributed, in recent years, to the management of upper gastrointestinal tract perforations by using the same principle of vacuum-assisted closure therapy of external wounds. The aim is to provide continuous wound drainage and to promote tissue granulation, decreasing the needed time to heal with a high rate of leakage closure.
A series of two different cases with clinical and radiological diagnosis of esophageal fistulas, recorded from 2018 to 2019 period at our institution, is presented. The first one is a case of anastomotic leak after esophagectomy for cancer complicated by pleuro-mediastinal abscess, while the second one is a leak of an esophageal suture, few days after resection of a bronchogenic cyst perforated into the esophageal lumen. Both cases were successfully treated with E-Vac therapy.
Our experience shows the usefulness of E-Vac therapy in the management of anastomotic and non-anastomotic esophageal fistulas. Further research is needed to better define its indications, to compare it to traditional treatments and to evaluate its long-term efficacy.
食管穿孔和上消化道术后吻合口漏的治疗仍然是一个挑战。近年来，腔内负压封闭（E-Vac）治疗通过应用相同的负压封闭治疗外部伤口的原理，对上消化道穿孔的治疗产生了积极的影响。其目的是提供持续的伤口引流，并促进组织肉芽形成，从而缩短愈合时间，并提高漏口闭合率。
本研究回顾性分析了 2018 年至 2019 年期间在我院确诊为食管瘘的两例不同病例，第一例是食管癌切除术后吻合口漏合并纵隔脓胸，第二例是支气管源性囊肿穿孔入食管腔后缝合处漏，两例均成功采用 E-Vac 治疗。
我们的经验表明，E-Vac 治疗在上消化道吻合口和非吻合口瘘的治疗中是有用的。需要进一步的研究来更好地定义其适应证，将其与传统治疗方法进行比较，并评估其长期疗效。
