Negative pressure, positive outcomes: A case report of Endovac therapy in complex sleeve gastrectomy leaks

Gastric fistula is one of the most feared complications of laparoscopic sleeve gastrectomy (LSG), potentially leading to patient mortality. Conventional treatments include surgery, conservative therapy, and stenting, each with variable success rates. Endoluminal Vacuum Therapy (EVT) is emerging as an innovative approach offering enhanced recovery through negative pressure.

We describe a 29-year-old man active smoker with no pre-existing comorbidities, who had severe postoperative complications after LSG, including bleeding and a refractory gastric fistula. Initial attempts to manage the complication with stenting and drainage were unsuccessful. Subsequent application of EVT using the Eso-Sponge system provided progressive resolution over repeated sessions, resulting in complete closure of the leak.

EVT involved incremental negative pressure adjustments, precise endoscopic-guided sponge placement and multidisciplinary clinical management. The Eso-Sponge was placed through an overtube under fluoroscopic and endoscopic guidance. Clinical and imaging outcomes confirmed substantial cavity reduction and normalization of inflammatory markers, leading to patient discharge after 40 days. EVT's effectiveness in complex leaks, supported by literature indicating success rates above 80 %, emphasizes its superiority over traditional modalities. However, given this is a single case, EVT should be considered a promising alternative rather than a definitive first-line therapy.

Endoluminal vacuum therapy significantly improves recovery and clinical outcomes in patients with complicated gastric leaks after sleeve gastrectomy and could be considered as a valuable option in selected cases.