Yohannes Alexander, Knievel Judith, Lange Jonas, Dormann Arno J, Hügle Ulrich, Eisenberger Claus F, Heiss Markus M
Center for Interdisciplinary Visceral Medicine, Department of Gastroenterology, Gastrointestinal Oncology, Gastrointestinal Infections and Nutritional Medicine, Cologne-Holweide and Merheim Medical Centers, 51109 Cologne, Germany.
Center for Interdisciplinary Visceral Medicine, Department of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, Witten/Herdecke University, 51109 Cologne, Germany.
Life (Basel). 2024 Jun 27;14(7):821. doi: 10.3390/life14070821.
Anastomotic insufficiencies are severe complications of abdominal surgery, often leading to prolonged hospitalization, serious tissue inflammation, and even sepsis, along with the need for recurrent surgery. Current non-surgical treatments such as self-expanding metal stents (SEMSs) and endoscopic vacuum therapy (EVT) have limitations, including stent migration or perforation. This review evaluates the effectiveness of the VacStent GI (Möller Medical GmbH, Fulda, Germany), a novel medical device combining SEMS and negative-pressure wound therapy in treating gastrointestinal leaks. Data were gathered from four prospective studies and compared with existing treatments. Studies on the VacStent GI application demonstrate technical success and competitive closure rates in upper gastrointestinal leaks, with minimal complications reported. Comparative analyses with SEMS and EVT reveal promising and most importantly equally good outcomes while maintaining the possibility for sustained enteral nutrition and reducing the risk of stent migration. The VacStent GI presents a promising alternative to current non-surgical treatments. Ongoing research aims to validate its efficacy in lower gastrointestinal leaks and comprehensively establish its role in leak management. Further investigation is necessary to confirm these findings and optimize treatment protocols. Future usages of the VacStent GI in colonic anastomotic insufficiencies promise an effective approach and might be able to lower the rates of necessary implementations of a stoma.
吻合口漏是腹部手术的严重并发症,常导致住院时间延长、严重的组织炎症,甚至败血症,还需要进行再次手术。目前的非手术治疗方法,如自膨式金属支架(SEMS)和内镜下负压治疗(EVT)存在局限性,包括支架移位或穿孔。本综述评估了VacStent GI(德国富尔达的Möller Medical GmbH公司)这一新型医疗器械在治疗胃肠道漏方面的有效性,该器械结合了SEMS和负压伤口治疗技术。数据来自四项前瞻性研究,并与现有治疗方法进行了比较。关于VacStent GI应用的研究表明,在上消化道漏的治疗中技术成功率高且闭合率具有竞争力,报告的并发症极少。与SEMS和EVT的比较分析显示出了良好的前景,最重要的是结果同样良好,同时保持了持续肠内营养的可能性并降低了支架移位的风险。VacStent GI为当前的非手术治疗提供了一种有前景的替代方案。正在进行的研究旨在验证其在下消化道漏治疗中的疗效,并全面确定其在漏口管理中的作用。需要进一步研究以证实这些发现并优化治疗方案。VacStent GI在结肠吻合口漏中的未来应用有望成为一种有效的方法,可能能够降低造口术的必要实施率。