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Abstract

Endoscopic Negative Pressure Therapy (ENPT) of an Anastomotic Leakage after Total Gastrectomy with Open-Pore PolyurethaneFoam Drainages (OPD) and Open-Pore Film Drainage (OFD)

Introduction: Anastomotic leak is the most severe postoperative complication after total gastrectomy. Endoscopic negative pressure therapy (ENPT) in the upper gastrointestinum has been developed to treat transmural defects. For ENPT openpore polyurethane-foam drainages (OPD) and open-pore film drainages (OFD) can be used to apply intracorporal negative pressure. ENPT was used to treat an anastomotic leak after total gastrectomy in a 71 year old patient who underwent palliative total gastrectomy. Material and method: Intracavitary variant of ENPT started 25 days after initial gastrectomy with placement of an OPD through the anastomotic defect into the extraluminale cavity. Negative pressure of -125 mmHg was applied with an electronic vacuum device. Simultaneously the cavity was drained, and defect closed. Drain was changed regularly after 3-4 days. After shrunken to a small channel the last period of treatment was done with a small-bore open-pore OFD. For construction a very thin double layered open-pore film (Suprasorb CNP, Drainage Film; Lohmann & Rauscher International GmbH & Co. KG, Rengsdorf, Germany) was used. Results: Total time to treat the anastomotic leakage with ENPT (OPD and OFD) was 14 days. The anastomotic leak was closed completely only with ENPT. After starting the ENPT a laparotomy was performed because of peritonitis and an intraabdominal negative pressure therapy was applied after lavage of the abdominal cavity for 3 days. We also used the double layered open-pore film (Suprasorb CNP, Drainage Film; Lohmann & Rauscher International GmbH & Co. KG, Rengsdorf, Germany). Conclusion: ENPT is an innovative endoscopic method in the treatment of anastomotic leaks of the upper gastrointestium. Open-pore polyurethane- foam and small-bore open-pore film drainages can be used for the new endoscopic closure method for gastrointestinal defects. Compared to OPD one advantage of the novel OFD is its small diameter.


Author(s):

Gunnar Loske*, Tobias Schorsch, Wolfgang Schulze, Henning Schmidt-Seithe and Christian T. Mueller



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