Giraldo-Grueso Manuel, Bolton Nathan, Brown Russell
Surgery Department, 5786Ochsner Clinic Foundation, New Orleans, LA, USA.
Am Surg. 2022 Apr;88(4):680-685. doi: 10.1177/00031348211041567. Epub 2021 Aug 29.
Perforation and anastomotic leakage of the upper gastrointestinal tract (UGI) has a high mortality and morbidity rate. Recently, UGI leaks have been treated with endoscopic vacuum therapy (EVT). However, this technique traditionally requires multiple EVT changes and a prolonged and uncomfortable nasoenteric intubation. We describe our experience using EVT through a novel pharyngostomy access to manage UGI leaks.
We describe our development and implementation of EVT via a novel pharyngostomy access to treat a variety of UGI defects. Preoperative, perioperative, and postoperative data were analyzed.
Six patients with UGI perforations or anastomotic leaks were treated with an EVT using a pharyngostomy access. The median age was 69 years (IQR 53-71). Four patients leaked after an Ivor Lewis esophagectomy, one after a robotic para-esophageal hernia repair, and another after a Roux en Y esophagojejunostomy. Defects were detected on a median of 11.5 days (IQR 3-21). Median values for the duration of the EVT therapy and the number of EVT changes were 19.5 days (IQR 14-31) and 7 (IQR 6.5-9), respectively. Four of the patients were discharged with an EVT in place and were successfully managed as outpatients. At a median follow-up of 8 months, two patients developed strictures. None of the patients required any surgical re-intervention, they tolerated oral intake, and all leakages were confirmed closed by imaging and endoscopy.
Endoscopic vacuum therapy can be successfully managed through a pharyngostomy access, as described. This access is easy, comfortable, and reliable and allows for a transition to outpatient management.
上消化道（UGI）穿孔和吻合口漏的死亡率和发病率很高。最近，上消化道漏已采用内镜下真空治疗（EVT）。然而，这项技术传统上需要多次更换EVT，并且需要长时间且令人不适的鼻肠插管。我们描述了我们通过一种新型咽造口途径使用EVT来处理上消化道漏的经验。
我们描述了通过新型咽造口途径开发和实施EVT以治疗各种上消化道缺损的情况。分析了术前、围手术期和术后的数据。
6例上消化道穿孔或吻合口漏患者通过咽造口途径接受了EVT治疗。中位年龄为69岁（四分位间距53 - 71岁）。4例患者在艾弗·刘易斯食管切除术后发生渗漏，1例在机器人辅助食管旁疝修补术后发生渗漏，另1例在Roux-en-Y食管空肠吻合术后发生渗漏。中位11.5天（四分位间距3 - 21天）发现缺损。EVT治疗持续时间的中位值和EVT更换次数分别为19.5天（四分位间距14 - 31天）和7次（四分位间距6.5 - 9次）。4例患者出院时仍保留EVT，作为门诊患者成功接受管理。中位随访8个月时，2例患者出现狭窄。所有患者均无需任何手术再次干预，能够耐受经口进食，并且通过影像学和内镜检查确认所有渗漏均已闭合。
如所述，内镜下真空治疗可通过咽造口途径成功实施。这种途径简便、舒适且可靠，并允许过渡到门诊管理。
