Ostapenko Alexander, Liechty Shawn, Kleiner Daniel
Department of General Surgery, Nuvance Health, CT, USA.
Department of General Surgery, Waterbury Hospital, CT, USA.
J Clin Transl Res. 2022 Oct 7;8(6):453-464. eCollection 2022 Dec 29.
Endoluminal vacuum therapy has been experimentally used in patients with esophageal, rectal, and Roux-en-Y bypass surgery. Yorkshire pigs are good animal models for studying the safety and efficacy of endoluminal vacuum therapy and prior studies have employed these devices in rectal anastomotic defects, as rescue therapy for early anastomotic leaks, as well as prophylactic therapy as a means of protecting high risk anastomosis.
The objective of this study is to assess the effects of a prophylactic vacuum assist device on bowel tissue surrounding an intact anastomosis at 30 days post device removal.
A total of seven pigs underwent a rectal resection with primary anastomosis: five experimental pigs with a prophylactic endoluminal vacuum device in place for 5 days post-surgery and two control pigs with no device. All animals were euthanized on the 35 post-operative day and subjected to a necropsy with a histopathological evaluation of the rectal anastomosis.
No significant difference in inflammation or strictures was observed between the anastomosis of animals with the endoluminal vacuum devices and controls.
We, therefore, conclude that endoluminal vacuum therapy is safe for prophylactic use in pigs undergoing low anterior resection and does not cause significant strictures.
Anastomotic leak is a feared complication resulting in increased costs, length of stay, and emotional distress. Endoluminal negative pressure vacuum therapy is a new technology that has been used in experimental models in both animals and humans for prevention and treatment of anastomotic leak. In this series we demonstrate endoluminal vacuum therapy is safe in a porcine model and does not result in stricture or increased adhesion formation. We expect endoluminal vacuum therapy to become more widely used in the future in both prevention and treatment of anastomotic leaks.
腔内负压治疗已在食管、直肠和Roux-en-Y旁路手术患者中进行了实验性应用。约克郡猪是研究腔内负压治疗安全性和有效性的良好动物模型，先前的研究已将这些装置用于直肠吻合口缺损，作为早期吻合口漏的挽救治疗，以及作为保护高风险吻合口的预防性治疗。
本研究的目的是评估预防性真空辅助装置在移除装置30天后对完整吻合口周围肠组织的影响。
共有7头猪接受了直肠切除并进行一期吻合：5头实验猪在术后放置预防性腔内负压装置5天，2头对照猪未放置装置。所有动物在术后第35天实施安乐死，并进行尸检及直肠吻合口的组织病理学评估。
使用腔内负压装置的动物与对照动物的吻合口在炎症或狭窄方面未观察到显著差异。
因此，我们得出结论，腔内负压治疗在接受低位前切除术的猪中预防性使用是安全的，不会导致明显的狭窄。
吻合口漏是一种令人担忧的并发症，会导致成本增加、住院时间延长和情绪困扰。腔内负压真空治疗是一种新技术，已在动物和人类的实验模型中用于预防和治疗吻合口漏。在本系列研究中，我们证明了腔内负压治疗在猪模型中是安全的，不会导致狭窄或粘连形成增加。我们预计腔内负压治疗在未来将更广泛地用于预防和治疗吻合口漏。
