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Updated: Nov 27, 2025
Endoscopic Vacuum Therapy for the Treatment of Anastomotic Leakage after Total Gastrectomy with Esophagojejunostomy
Published on: August 22, 2025
Preemptive endoluminal vacuum therapy after pancreaticoduodenectomy: A case report
Flaubert Sena de Medeiros1, Epifanio Silvino do Monte Junior2, Romero de Lima França3
1Department of Surgery, Federal University of Rio Grande do Norte, Natal 59012-300, Rio Grande do Norte, Brazil.
Background:
Pancreaticoduodenectomy is a technically demanding operation, with reported morbidity rates of approximately 40%-50%. A novel idea is to use endoscopic vacuum therapy (EVT) in a preemptive setting to prevent anastomotic leakage and pancreatic fistulas. In a recent case series, EVT was proven to be effective in preventing leaks in patients with anastomotic ischemia. There have been no previous reports on preemptive EVT after pancreaticoduodenectomy.
Case Summary:
We describe the case of a 71-year-old woman with hypertension and diabetes who was admitted to the emergency room with jaundice, choluria, fecal acholia, abdominal pain, and fever. Admission examinations revealed leukocytosis and hyperbilirubinemia (total: 13 mg/dL; conjugated: 12.1 mg/dL). Abdominal ultrasound showed cholelithiasis and dilation of the common bile duct. Magnetic resonance imaging demonstrated a stenotic area, and a biopsy confirmed cholangiocarcinoma. Considering the high risk of leaks after pancreatico-duodenectomy, preemptive endoluminal vacuum therapy was performed. The system comprised a nasogastric tube, gauze, and an antimicrobial incise drape. The negative pressure was 125 mmHg, and no adverse events occurred. The patient was discharged on postoperative day 5 without any symptoms.
Conclusion:
Preemptive endoluminal vacuum therapy may be a safe and feasible technique to reduce leaks after pancreaticoduodenectomy.
