TY  - JOUR
A1  - Reimer, Stanislaus
A1  - Lock, Johan F.
A1  - Flemming, Sven
A1  - Weich, Alexander
A1  - Widder, Anna
A1  - Plaßmeier, Lars
A1  - Döring, Anna
A1  - Hering, Ilona
A1  - Hankir, Mohammed K.
A1  - Meining, Alexander
A1  - Germer, Christoph-Thomas
A1  - Groneberg, Kaja
A1  - Seyfried, Florian
T1  - Endoscopic management of large leakages after upper gastrointestinal surgery
JF  - Frontiers in Surgery
N2  - Background
Endoscopic vacuum therapy (EVT) is an evidence-based option to treat anastomotic leakages of the upper gastrointestinal (GI) tract, but the technical challenges and clinical outcomes of patients with large defects remain poorly described.

Methods
All patients with leakages of the upper GI tract that were treated with endoscopic negative pressure therapy at our institution from 2012–2021 were analyzed. Patients with large defects (>30 mm) as an indicator of complex treatment were compared to patients with smaller defects (control group).

Results
Ninety-two patients with postoperative anastomotic or staplerline leakages were identified, of whom 20 (21.7%) had large defects. Compared to the control group, these patients required prolonged therapy (42 vs. 14 days, p < 0.001) and hospital stay (63 vs. 26 days, p < 0.001) and developed significantly more septic complications (40 vs. 17.6%, p = 0.027.) which often necessitated additional endoscopic and/or surgical/interventional treatments (45 vs. 17.4%, p = 0.007.) Nevertheless, a resolution of leakages was achieved in 80% of patients with large defects, which was similar compared to the control group (p = 0.42). Multiple leakages, especially on the opposite side, along with other local unfavorable conditions, such as foreign material mass, limited access to the defect or extensive necrosis occurred significantly more often in cases with large defects (p < 0.001).

Conclusions
Overall, our study confirms that EVT for leakages even from large defects of the upper GI tract is feasible in most cases but comes with significant technical challenges.
KW  - anastomotic leakage
KW  - endoluminal
KW  - vacuum-assisted closure
KW  - negative pressure
KW  - endoscopic
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-274044
SN  - 2296-875X
VL  - 9
ER  - 
TY  - JOUR
A1  - Krajinovic, K.
A1  - Reimer, S.
A1  - Kudlich, T.
A1  - Germer, C. T.
A1  - Wiegering, A.
T1  - “Rendezvous technique” for intraluminal vacuum therapy of anastomotic leakage of the jejunum
JF  - Surgical Case Reports
N2  - Background

Anastomotic leakage (AL) is one of the most common and serious complications following visceral surgery. In recent years, endoluminal vacuum therapy has dramatically changed therapeutic options for AL, but its use has been limited to areas easily accessible by endoscope.

Case presentation

We describe the first use of endoluminal vacuum therapy in the small intestine employing a combined surgical and endoscopic “rendezvous technique” in which the surgeon assists the endoscopic placement of an endoluminal vacuum therapy sponge in the jejunum by means of a pullback string. This technique led to a completely closed AL after 27 days and 7 changes of the endosponge.

Conclusion

The combined surgical and endoscopic rendezvous technique can be useful in cases of otherwise difficult endosponge placement.
KW  - endosponge
KW  - anastomotic leakage
Y1  - 2016
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-147883
VL  - 2
IS  - 114
ER  -