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Updated: May 26, 2026
04:05
Endoscopic Vacuum Therapy for the Treatment of Anastomotic Leakage after Total Gastrectomy with Esophagojejunostomy
Published on: August 22, 2025
Caveats in using vacuum-assisted closure for post-pneumonectomy empyema
Gaetano Rocco1, Ciriaco Cecere, Antonello La Rocca
1Department of Thoracic Surgery and Oncology, National Cancer Institute, Naples, Italy. gaetano.rocco@btopenworld.com
Summary
Vacuum-assisted closure (VAC) for chronic empyemas may allow outpatient care. However, VAC use in post-pneumonectomy patients can lead to complications, requiring careful monitoring before discharge.
Area of Science:
- Thoracic Surgery
- Critical Care Medicine
Background:
- Chronic empyemas often necessitate prolonged hospitalization.
- Vacuum-assisted closure (VAC) offers potential for outpatient management of empyemas.
Purpose of the Study:
- To evaluate the feasibility and safety of VAC for post-pneumonectomy empyema patients.
Main Methods:
- Three patients with post-pneumonectomy bronchopleural fistula underwent open window thoracostomy (OWT) followed by VAC therapy.
- Endobronchial stents were used to close fistulas in two patients.
- VAC system applied median 35 days post-pneumonectomy; patients seen every three days for sponge changes.
Main Results:
- VAC treatment was discontinued in all patients due to complications like hypotension and severe thoracic pain.
- One patient required VATS for sponge removal due to inability to extract them through OWT.
Conclusions:
- While VAC may aid in obliterating post-pneumonectomy empyema cavities, its application carries risks of significant complications.
- Close patient monitoring is crucial during the early VAC treatment phase before considering outpatient management.
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