Agosta Marcello, Sofia Maria, Mazzone Chiara, Greco Luigi Piero, Faletra Gloria, Latteri Saverio
Cannizzaro Hospital, Department of General Surgery, Catania 95126, Italy.
Cannizzaro Hospital, Department of General Surgery, Catania 95126, Italy.
Int J Surg Case Rep. 2025 Jul;132:111453. doi: 10.1016/j.ijscr.2025.111453. Epub 2025 May 19.
Gastric fistula is one of the most feared complications of laparoscopic sleeve gastrectomy (LSG), potentially leading to patient mortality. Conventional treatments include surgery, conservative therapy, and stenting, each with variable success rates. Endoluminal Vacuum Therapy (EVT) is emerging as an innovative approach offering enhanced recovery through negative pressure.
We describe a 29-year-old man active smoker with no pre-existing comorbidities, who had severe postoperative complications after LSG, including bleeding and a refractory gastric fistula. Initial attempts to manage the complication with stenting and drainage were unsuccessful. Subsequent application of EVT using the Eso-Sponge system provided progressive resolution over repeated sessions, resulting in complete closure of the leak.
EVT involved incremental negative pressure adjustments, precise endoscopic-guided sponge placement and multidisciplinary clinical management. The Eso-Sponge was placed through an overtube under fluoroscopic and endoscopic guidance. Clinical and imaging outcomes confirmed substantial cavity reduction and normalization of inflammatory markers, leading to patient discharge after 40 days. EVT's effectiveness in complex leaks, supported by literature indicating success rates above 80 %, emphasizes its superiority over traditional modalities. However, given this is a single case, EVT should be considered a promising alternative rather than a definitive first-line therapy.
Endoluminal vacuum therapy significantly improves recovery and clinical outcomes in patients with complicated gastric leaks after sleeve gastrectomy and could be considered as a valuable option in selected cases.
胃瘘是腹腔镜袖状胃切除术（LSG）最令人担忧的并发症之一，可能导致患者死亡。传统治疗方法包括手术、保守治疗和支架置入术，每种方法的成功率各不相同。腔内负压治疗（EVT）作为一种创新方法正在兴起，通过负压可促进恢复。
我们描述了一名29岁的男性，有吸烟习惯，无既往合并症，在LSG术后出现严重并发症，包括出血和难治性胃瘘。最初尝试用支架置入和引流来处理并发症未成功。随后使用Eso-Sponge系统进行EVT，经过多次治疗逐渐好转，最终瘘口完全闭合。
EVT包括逐步调整负压、在内镜精确引导下放置海绵以及多学科临床管理。Eso-Sponge在荧光镜和内镜引导下通过外套管置入。临床和影像学结果证实腔隙明显缩小，炎症指标恢复正常，患者在40天后出院。文献表明EVT在复杂瘘口治疗中的成功率高于80%，这支持了其相对于传统方法的优越性。然而，鉴于这是单个病例，EVT应被视为一种有前景的替代方法，而非确定性的一线治疗方法。
腔内负压治疗显著改善了袖状胃切除术后复杂胃瘘患者的恢复情况和临床结局，在特定病例中可被视为一种有价值的选择。
