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Updated: Nov 25, 2025

Endoscopic Vacuum Therapy for the Treatment of Anastomotic Leakage after Total Gastrectomy with Esophagojejunostomy
04:05

Endoscopic Vacuum Therapy for the Treatment of Anastomotic Leakage after Total Gastrectomy with Esophagojejunostomy

Published on: August 22, 2025

375

Prophylactic negative vacuum therapy of high-risk esophageal anastomoses in pediatric patients

Jessica L Yasuda1, Wendy Jo Svetanoff2, Steven J Staffa3

  • 1Division of Gastroenterology, Hepatology and Nutrition; Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States.

Journal of Pediatric Surgery
|December 21, 2020
PubMed

Insights

Prophylactic vacuum-assisted closure (VAC) therapy did not reduce esophageal anastomotic leaks. However, it was linked to a significantly higher rate of long-term anastomotic failure, indicating potential risks.

Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Medical Device Technology

Background:

  • Esophageal anastomoses carry risks of leak and stricture formation.
  • Vacuum-assisted closure (VAC) therapy is established for treating anastomotic leaks.
  • Prophylactic application of VAC (pEVAC) was investigated to prevent complications.

Purpose of the Study:

  • To evaluate the efficacy of prophylactic vacuum-assisted closure (pEVAC) in reducing leaks and strictures in high-risk esophageal anastomoses.
  • To compare the incidence of anastomotic leak and long-term anastomotic failure between patients receiving pEVAC and those not receiving it.

Main Methods:

  • A single-center retrospective case-control study was conducted.
  • Patients undergoing high-risk esophageal anastomoses between July 2015 and January 2019 were included.
  • Outcomes of leak and long-term anastomotic failure were compared between pEVAC and control groups.

Main Results:

  • Prophylactic VAC placement (pEVAC) in 16 patients showed an 18.8% leak rate.
  • Leak rates in controls were 22% for Foker repairs and 5% for stricture resections (p > 0.05).
  • Long-term anastomotic failure was significantly higher in the pEVAC cohort (56.3%) compared to controls (11.5%) (p < 0.001).

Conclusions:

  • Prophylactic EVAC placement does not appear to reduce anastomotic leak rates.
  • pEVAC is associated with significantly increased odds of long-term anastomotic failure.
  • Further research is needed on patient selection, device design, and therapy duration for potential prophylactic use.
Abstract

Keywords:
Esophageal atresiaEsophageal leakEvacVacuum assisted closure

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