Endoscopic vacuum therapy for the treatment of suture failure after resection of the esophageal wall for removal of an enterogenic cyst in a 9-year-old child

INTRODUCTION. Intrathoracic esophageal postoperative suture’s failure occurs in 8–26 % after distal esophagectomy and 3–12 % after total gastrectomy, also this leads to the development of life-threatening complications and a rather high mortality rate. Endoscopic vacuum therapy is an actively developing and modern method of treating defects in the wall of hollow organs.

CINICAL EXAMPLE. 9-year-old patient had resection of the esophageal wall for an enterogenic cyst. The failure of the postoperative suture was clinically diagnosed after the 1st day of operation, confirmed by endoscopic and X-ray findings. We decided to use endoscopic vacuum therapy with Suprasorb sponge. The sponge was replaced at intervals of 3–5 days. On the 9th twenty-four hours after the operation, a delimited cavity into the mediastinal pleural space with a length of 8 cm and a width 1.5 cm with fibrin deposits on the walls was diagnosed.  The size and shape of the sponge depended on the size of the defect of the esophageal wall and the volume of the delimited cavity. Conservative and rehabilitation therapy was also carried out. On the 40th day after the operation, complete epithelialization of the esophageal wall defect was noted. The patient was discharged in a satisfactory condition. Due to the results of our clinical observation, we reached a conclusion that endoscopic vacuum therapy is applicable in clinical practice, because it is an effective method of treatment for the of intra-thoracic esophageal suture’s failure. The technique is relatively safe, contributes to the complete elimination of the full-wall defect, reducing the period of social recovery and maintaining a high quality of life after treatment.

1. Cereatti F., Grassia R., Drago A. et al. Endoscopic management of gastrointestinal leaks and fistulae: What option do we have? // World J Gastroenterol. 2020;26(29):4198–4217.

2. Blencowe N. S, Strong S., McNair A. G. et al. Reporting of short-term clinical outcomes after esophagectomy: a systematic review // Ann Surg. 2012;(255):658–666.

3. Lang H., Piso P., Stukenborg C. et al. Management and results of proximal anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma // Eur. J. Surg. Oncol. 2000;(26):168–171.

4. Kulish P. A., Popov A. Y., Porhanov V. A., Baryshev A. G., Slavinsky V. G., Kovalenko A. L., Bykov M. I., Sholin I. Y., Chaykin V. V. Immediate results after vacuum drainage endoscopic treatment in patients with full esophageal wall defects // Innovative Medicine of Kuban. 2016;(2):27– 34. (In Russ.).

5. Watkins J. R., Farivar A. S. Endoluminal Therapies for Esophageal Perforations and Leaks // Thorac. Surg. Clin. 2018;28(4):541–554.

6. Wedemeyer J., Schneider A., Manns M. et. al. Endoscopic vacuumassisted closure of upper intestinal anastomotic leaks // Gastrointest Endosc. 2007;64(4):708–711.

7. Kähler G. Anastomotic Leakage after Upper Gastrointestinal Surgery: Endoscopic Treatment // Visceral Medicine. 2017;33(3):202–206.

8. Berlth F., Bludau M., Sven Plum P. et al. Self-Expanding Metal Stents Versus Endoscopic Vacuum Therapy in Anastomotic Leak Treatment After Oncologic Gastroesophageal Surgery // Journal Of Gastrointestinal Surgery: Official Journal Of The Society For Surgery Of The Alimentary Tract. 2018;23:67–75.