Post written by Mateus Pereira Funari, MD, Antonio Madruga Coutinho Neto, MD, Galileu Ferreira Ayala Farias, MD, Eduardo Guimarães Hourneaux de Moura, MD, PhD, Marcos Eduardo Lera dos Santos, MD, from the Clinics Hospital of the São Paulo University Medical School (HC-FMUSP), São Paulo, São Paulo, Brazil.
We describe the case of a 70-year-old male patient submitted to a laparotomy with total gastrectomy and Roux-en-Y reconstruction and esophagojejunal anastomosis for a gastric adenocarcinoma. Three weeks after the surgery, he developed with sepsis from an anastomic fistula and began management with intracavitary endoscopic vacuum therapy (EVT). After 2 weeks, the collection improved significantly, and the endoluminal vacuum was placed. After 3 weeks of EVT, there was only a remnant fistulous tract. The patient was discharged from the hospital with a regular oral diet, and the fistulous tract was treated with 1 double pigtail plastic stent. Four weeks after the pigtail stent placement, the fistula was totally resolved, and the patient resumed his normal life.
Because endoscopic vacuum therapy is an emergent, efficient, cheap, and reproducible method to treat one of the most important adverse events after GI surgery (fistulas and leaks), it’s use should be encouraged among gastroenterologists and further studies may help to improve and spread this therapy in order to save more lives.
Vacuum therapy is reproducible anywhere, even in places with poor infrastructure. More important than that, its mechanism and efficacy should be well understood by physicians. Our case shows exactly that.
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