Treatment with vacuum-assisted closure system: A case of anastomotic leak after upper gastrointestinal surgery

Presently described is a case treated via stent and vacuum-assisted closure (VAC). The patient developed an oesophagojejunostomy leak (OL) on the ninth postoperative day after a radical total gastrectomy. The patient was a 55-year-old male patient with adenocarcinoma localized to the small curvature on the corpus of the stomach. Relaparatomy was performed for the OL, including placement of an uncovered stent. The abdomen was washed 4 times. As the OL did not decrease, 2 covered stents (22 mm and 18 mm in diameter and 80 mm long) were inserted endoscopically. The OL continued to contaminate the abdomen. One tip of the VAC sponge was placed next to the anastomosis, and the other tip was removed from the left upper quadrant. Another VAC closure set was placed in the abdomen. Both VAC closures were connected to separate vacuum devices with 75 mmHg of pressure. VAC dressings were changed at regular intervals every 3 days, and these steps were repeated 7 times over 21 days. The covered stents were removed endoscopically in the final operation. Fistulography revealed that the OL was completely closed, and the VAC dressings were removed. The skin was closed by separating the subcutaneous oil layer of the fascia. VAC therapy can not only provide serious abdominal sepsis treatment and primary source control, but also accelerate granulation development and, in this case, quickly closed the anastomotic leakage.

Vakum yardýmlý kapama sistemi ile tedavi: Üst gastrointestinal cerrahiden sonra anastomoz kaçaðý olan bir olgu.

Radikal total gastrektomi sonrasý postoperatif dokuzuncu günde ozofagojejunostomiden kaçak nedeniyle stent ve vakum yardýmlý kapatma uyguladýðýmýz olguyu sunmayý amaçladýk. Mide corpus küçük kurvatüründe adenokarsinom olan 55 yaþýndaki erkek hastaya radikal total gastrektomi yapýldý. Postoperatif dokuzuncu günde anastomoz kaçaðý saptanmasý nedeniyle, kapsýz stent yerleþtirilmesini de içeren relaparatomi yapýldý. Daha sonra karýn 4 defa yýkandý. Kaçak azalmadýðýndan 22 ve 18 mm çapýnda 80 mm uzunluðundaki 2 kaplý stent içiçe endoskopik olarak yerleþtirildi. Kaçak batýný kirletmeye devam etti. Beþinci defa batýn yýkama esnasýnda vakum yardýmlý kapama (VAC) sistemi ile tedavi yönetimine karar verildi. VAC süngerinin bir ucu anastomozun yanýna yerleþtirildi ve diðer ucu sol üst kadrandan çýkarýldý. Batýn içine baþka bir VAC kapama seti yerleþtirildi. Her iki VAC, 75 mmHg basýnç ile iki ayrý vakum cihazýna baðlandý. VAC deðiþiklikleri her üç günde bir düzenli aralýklarla 21 gün içinde yedi defa tekrarlandý. Kaplý stentler son operasyonda endoskopik olarak çýkarýldý. Postoperatif 36.gündeki fistülografide kaçaðýn tamamen kapandýðýný görüldü ve VAC sistemi çýkarýldý. Cilt, fascia üzerindeki subkütan yað tabakasýný ayýrarak kapatýldý. VAC sistemlerinin uygulanmasý, ciddi batýn içi sepsis tedavisi ve birincil kaynak kontrolü saðlamakla kalmaz ayný zamanda granülasyon geliþimini hýzlandýrýr ve anastomoz kaçaðýný daha kýsa zaman içinde kapatýr.