ENDOSCOPIC VACUUM-ASSISTED CLOSURE (E-VAC) IN ACUTE MEDIASTINITIS FROM ANASTOMOTIC LEAKAGE AFTER INTRATHORACIC ESOPHAGEAL JEJUNAL ANASTOMOSIS

Our aim was to assess the role of negative pressure therapy in the treatment of anastomotic leakage, after intrathoracic esophageal jejunal anastomosis by the evaluation of the time required for healing and the functional outcomes of patients. We present the case of a 73 years old male patient admitted in our clinic with esophageal perforation that appeared possible after a left thoracotomy necessary for an intrathoracic esophageal jejunal Roux-en-Y procedure, after a total gastrectomy for gastric neoplasm. There are groups that propose different approaches such as surgery variations or combinations of the surgery with or without adjuvant treatments, as the use of a hyperbaric chamber or vacuum devices such as Endoscopic Vacuum-Assisted Closure (E-VAC). Using a modified double-lumen naso-gastric probe adapted to the negative pressure unit and using the same principle as in the negative pressure treatment of soft tissue wounds we have achieved positive results with successful cure of esophageal perforation. The toraco-abdominal computed tomography done with contrast substance confirmed the esophageal perforation. The patient had a full recovery after 19 days of hospitalization with a positive check-up at one and two months after leaving our clinic. After the basic wound treatment, auxiliary methods such as negative pressure contributed to healing. Endoscopic vacuum treatment for parietal lesions of the esophageal wall is a great procedure in the management of this pathology with a high mortality and the surgeons and gastroenterologist must have considered as a treatment option in this kind of lessons. The prospective and comparative studies are necessary for the evaluation of this new and minim invasive procedure.