[Endoscopic negative pressure therapy of a post-laryngectomy pharyngocutaneous fistula-first report of a new therapeutic method. German version]. / Endoskopische Unterdrucktherapie einer pharyngokutanen Fistel nach Laryngektomie ­ Erstbeschreibung eines neuen Therapieverfahrens.

In the current first report, it is shown how a post-laryngectomy pharyngocutaneous fistula was successfully closed by endoscopic negative pressure therapy (ENPT; also termed endoscopic vacuum therapy, EVT). The duration of negative pressure treatment was 14 days. Up until now, ENPT has been used for treatment of transmural defects in the rectum and esophagus. The new endoscopic method can also be used in the ENT field for closure of pharyngocutaneous fistulas.

Endoscopic negative pressure therapy (ENPT) of a post-laryngectomy pharyngocutaneous fistula: first report of a new treatment method.

In the current first report, it is shown how a post-laryngectomy pharyngocutaneous fistula was successfully closed by endoscopic negative pressure therapy (ENPT; also termed endoscopic vacuum therapy, EVT). The duration of negative pressure treatment was 14 days. Up until now, ENPT has been used for treatment of transmural defects in the rectum and esophagus. The new endoscopic method can also be used in the ENT field for closure of pharyngocutaneous fistulas.

Intrathoracic negative pressure therapy for pleural empyema using an open-pore drainage film.

BACKGROUND: We report our initial experience with intrathoracic negative pressure therapy (ITNPT) in the stage-adjusted treatment of pleural empyema (PE) based on a case series. MATERIALS AND METHODS: ITNPT represents a further development for intrathoracic use. After thoracic surgical open debridement, an intrathoracic negative pressure dressing was inserted. The drainage elements were a thin open-pore double-layer drainage film (OF) with open-pore polyurethane foams (PUF). Only the OF was placed in direct contact with the lung parenchyma. Negative pressure was generated using an electronic pump (continuous suction, -75 mm Hg). In revision thoracotomies, ITNPT was stopped or continued depending on local findings. RESULTS: In total, 31 patients with stage II and III pleural empyema underwent ITNPT, which was administered during the primary procedure (n = 17) or at revision (n = 14). Treatment duration was a mean of 10 days (2-18 days) with a mean change interval of 4 days (2-6 days). Intrathoracic negative pressure dressings were applied a mean of 3.5 (1-6) times. The empyema cavity continuously reduced in size and was cleansed by the suction. The OF has a minimum intrinsic volume with maximum absorption surface. Once negative pressure is established, there is no intrathoracic dead volume and the parenchyma can expand. The protective material properties of OF make ITNPT suitable for the treatment of pleural empyema. Targeted local intrathoracic drainage of the septic focus is a possible adjunct to surgery. The surgical dressings must be changed repeatedly. The method is suitable for the treatment of complex stage II and III pleural empyemas. CONCLUSION: The OF can be used as an intrathoracic drainage element for ITNPT in pleural empyema. This new application option expands the range of indications for negative pressure therapy.

[Postoperative leaks in the gastrointestinal tract-diagnosis and treatment]. / Postoperative Leckagen im Gastrointestinaltrakt ­ Diagnostik und Therapie.

Postoperative leaks following esophageal, gastric, colonic or rectal resection represent a life-threatening complication that is associated with high morbidity and mortality. Leaks are generally diagnosed with a combination of the following: recognition of clinical deterioration, laboratory results, endoscopic and radiological imaging. In case of intraperitoneal leaks, surgery is mandatory. In case of mediastinal or retroperitoneal anastomotic insufficiencies, treatment mainly comprises interventional endoscopic procedures in an interdisciplinary approach. For endoscopic therapy, there are mainly two different methods described: closure of the defect with fully covered self-expandable stents with external drainage and closure of the defect with simultaneously internal drainage by endoscopic vacuum therapy.

Intraluminal and intracavitary vacuum therapy for esophageal leakage: a new endoscopic minimally invasive approach.

Endoscopic treatment by placement of a vacuum sponge drainage system is a new option in the management of leakages in the digestive tract. We now distinguish between two treatment variants: the intracavitary and intraluminal techniques. A drainage system comprising an appropriately trimmed polyurethane foam sponge and a gastric-type tube is either placed through the esophageal defect into an extraluminal wound cavity (intracavitary method), or directly onto the defect with the sponge remaining within the esophageal lumen (intraluminal method). Continuous negative pressure of 125 mmHg is then applied, resulting in stabilizing of the sponge and continuous drainage and sealing of the defect. We report a case series of 14 patients, presenting the full range of possible esophageal defects that were successfully treated with either intracavitary or intraluminal vacuum therapy. Complete healing of the esophageal defect was achieved in 13 patients; one patient died due to fulminant pseudomembranous colitis while the esophageal defect was nearly healed.

[Vacuum therapy of an esophageal anastomotic leakage--a case report]. / Vakuumtherapie einer Anastomoseninsuffizienz am Osophagus--ein Fallbericht.

BACKGROUND: Esophageal anastomotic leakage is a major complication. In rectal surgery, anastomotic dehiscence is successfully treated by endoscopically placed intracavitary vacuum sponge systems. We used this technique in a case of anastomotic dehiscence following transhiatal gastrectomy. PATIENT AND METHOD: In an 80-year-old female patient esophageal anastomotic leakage was diagnosed endoscopically six days following transhiatal gastrectomy. Endocavitary treatment by endoscopic implantation of a vacuum sponge system was performed. After 14 days of treatment with 4 system changes and a change interval of 2-4 days complete healing was observed. A week later, a second wall defect was diagnosed and treated in the same way. The total hospital stay after operation was sixty days. CONCLUSION: Esophageal anastomotic leakage can be successfully treated by means of an endoscopically placed intracavitary vacuum sponge system. This paper describes the therapeutic technique.

Endoscopic negative pressure therapy of the upper gastrointestinal tract.

Endoscopic negative pressure therapy (ENPT) has been adapted for upper gastrointestinal tract applications. More than 400 patients have already been treated with ENPT due to transmural defects in the upper gastrointestinal tract, with a success rate of 87%. The greatest experience exists for the treatment of anastomotic leakages and perforations of the esophagus. The ENPT is also used in the duodenum, pancreas and for complications after bariatric surgery. There are new indications that go beyond treatment in complication management. Innovative drainage types and endoscopic techniques have been developed that broaden the spectrum of applications. The aim of this article is to give an overview of the current status of ENPT in the upper gastrointestinal tract.

Tips and tricks for endoscopic negative pressure therapy.

Endoscopic negative-pressure therapy (ENPT) is becoming a valuable tool in surgical complication management of transmural intestinal defects and wounds in the upper and lower gastrointestinal tract. Innovative materials for drains have been developed, endoscopic techniques adapted, and new indications for ENPT have been found. Based on our broad clinical experience, numerous tips and tricks are described, which contribute to the safety of dealing with the new therapy. The aim of this work is to present these methods. The focus is on describing the treatment in the esophagus.

[Endoscopic negative pressure therapy of the upper gastrointestinal tract. German version]. / Endoskopische Unterdrucktherapie am oberen Gastrointestinaltrakt.

Endoscopic negative pressure therapy (ENPT) has been adapted for upper gastrointestinal tract applications. More than 400 patients have already been treated with ENPT due to transmural defects in the upper gastrointestinal tract, with a success rate of 87%. The greatest experience exists for the treatment of anastomotic leakages and perforations of the esophagus. The ENPT is also used in the duodenum, pancreas and for complications after bariatric surgery. There are new indications that go beyond treatment in complication management. Innovative drainage types and endoscopic techniques have been developed that broaden the spectrum of applications. The aim of this article is to give an overview of the current status of ENPT in the upper gastrointestinal tract.

[Tips and tricks for endoscopic negative pressure therapy. German version]. / Tipps und Tricks in der endoskopischen Unterdrucktherapie.

Endoscopic negative-pressure therapy (ENPT) is becoming a valuable tool in surgical complication management of transmural intestinal defects and wounds in the upper and lower gastrointestinal tract. Innovative materials for drains have been developed, endoscopic techniques adapted, and new indications for ENPT have been found. Based on our broad clinical experience, numerous tips and tricks are described, which contribute to the safety of dealing with the new therapy. The aim of this work is to present these methods. The focus is on describing the treatment in the esophagus.

[First report of urinary endoscopic vacuum therapy : For large bladder defect after abdomino-perineal excision of the rectum. Video paper. German version]. / Erstbeschreibung einer endoskopischen Vakuumtherapie der ableitenden Harnwege : Bei großem Harnblasendefekt nach abdomino-perinealer Rektumexstirpation. Videobeitrag.

PURPOSE: The technique of active urinary endoscopic vacuum therapy (uEVT) is described. The surgical technique is demonstrated in detail with the help of a video of the operation and which is available online. Vesical fistulas are a rare complication following rectal surgery. The EVT technique is a novel method for treatment of gastrointestinal leakage. This endoscopic procedure has been adapted to treat a large bladder defect after abdominoperineal resection of the rectum with urine flowing out of the perineal wound. MATERIAL AND METHOD: A new open-pore film drainage (OFD) catheter with an external diameter of only a few millimeters has been developed and is constructed from a very thin open-pore double-layered film and a drainage tube. The OFD was inserted into the bladder by means of flexible endoscopy and channeled out through a suprapubic incision. Continuous suction was applied with an electronic vacuum pump to actively drain the urine completely. A passive catheter drainage of urine from the renal pelvis via transurethral single J stent was carried out simultaneously during the complete duration of treatment. The healing process was monitored during and after therapy by intravesical endoscopy. RESULTS: The application of continuous negative pressure via the OFD resulted in total collapse of the bladder. The urine in the bladder was actively and permanently drained through the OFD. Urine leakage from the perineal wound stopped immediately after induction of suction. After 18 days of treatment with the uEVT the bladder defect was healed. After therapy and removal of the catheters the patient had normal micturition. CONCLUSION: A novel small-bore OFD has been developed for EVT. The OFD technique now allows endoscopic application of negative pressure in the bladder. This first successful experience proves uEVT to be a potent interventional alternative in the treatment of bladder defects.

First report of urinary endoscopic vacuum therapy : For large bladder defect after abdomino-perineal excision of the rectum. Video paper.

PURPOSE: The technique of active urinary endoscopic vacuum therapy (uEVT) is described. The surgical technique is demonstrated in detail with the help of a video of the operation, which is available online. Vesical fistulas are a rare complication following rectal surgery. The EVT technique is a novel method for the treatment of gastrointestinal leakage. This endoscopic procedure has been adapted to treat a large bladder defect after abdomino-perineal resection of the rectum with urine flowing out of the perineal wound. MATERIALS AND METHODS: A new open-pore film drainage (OFD) catheter with an external diameter of only a few millimeters was developed and constructed from a very thin open-pore double-layered film and a drainage tube. The OFD was inserted into the bladder by means of flexible endoscopy and channeled out through a suprapubic incision. Continuous suction was applied with an electronic vacuum pump to actively drain the urine completely. A passive catheter drainage of urine from the renal pelvis via a transurethral single J stent was carried out simultaneously during the complete duration of treatment. The healing process was monitored during and after therapy via intravesical endoscopy. RESULTS: The application of continuous negative pressure via the OFD resulted in total collapse of the bladder. The urine in the bladder was actively and permanently drained through the OFD. Urine leakage from the perineal wound stopped immediately after induction of suction. The bladder defect healed after 18 days of treatment with uEVT. After therapy and removal of the catheters, the patient had normal micturition. CONCLUSION: A novel small-bore OFD was developed for EVT. The OFD technique allows for endoscopic application of negative pressure in the bladder. This first successful experience proves uEVT to be a potent interventional alternative in the treatment of bladder defects.

[Endoscopic vacuum therapy for Boerhaave's syndrome]. / Endoskopische Vakuumtherapie beim Boerhaave-Syndrom.

INTRODUCTION: Operative and interventional treatment of Boerhaave's syndrome include closure of the esophageal defect and drainage of the septic focus. Initial reports on the use of endoscopic vacuum therapy (EVT) of Boerhaave's syndrome are now available. This article describes the experiences gained from the clinical application in two patients using this new surgical endoscopic procedure. The current literature regarding treatment of Boerhaave's syndrome is presented. MATERIAL AND METHODS: Open-pore drainage is endoscopically placed either through the transmural defect in the extraluminal wound cavity (intracavitary EVT) or overlapping the defect into the esophageal lumen (intraluminal EVT). The application of a negative pressure results in active drainage directed to the lumen and simultaneously in defect closure. Through these therapeutic measures the perforation defect and the septic focus can be healed. Open-pore drains are manufactured from drainage tubes and open-pore foam or an open-pore film. RESULTS: In both patients the distal esophageal perforation defects were completely healed using EVT. In 1 patient the treatment with EVT alone lasted 8 days. For the second patient EVT was combined with an open thoracotomy for decortication of pleural empyema. The treatment with EVT lasted 23 days and 1 cycle of EVT was carried out with an new open-pore film drainage (OFD). Surgical treatment to close the defect or an esophageal resection was not necessary for both patients. In the currently available studies and single case reports of ETV for Boerhaave's syndrome, 11 patients (84 %) of a total of 13 patients have been successfully treated. CONCLUSION: First clinical experiences have demonstrated that with EVT draining of the septic focus and closure of the Boerhaave defect at the gastroesophageal junction can be achieved. The EVT is an organ-preserving endoscopic surgical treatment, which can be an alternative and complementary to traditional surgery.

[Complex vacuum therapy of an abdominal abscess from gastric perforation : case report of innovative operative endoscopic management]. / Komplexe Vakuumtherapie einer abszedierenden Magenperforation : Fallbericht eines innovativen operativ endoskopischen Managements.

BACKGROUND: The simultaneous use of abdominal and endoscopic vacuum therapy in a case of an abdominal abscess caused by gastric perforation is demonstrated and innovative operative endoscopic management is described. CASE REPORT: A computed tomography scan performed on a 67-year-old female patient showed a large abscess of the upper abdominal cavity where laparoscopic fundoplication had been performed 6 months previously. Endoscopy showed a transmural perforation of the dorsal wall of the stomach. The gastric perforation was closed and drained using intracavitary endoscopic vacuum therapy. Open pore polyurethane foam drainage was inserted through the defect into the extraluminal cavity for 3 days. A second period of therapy followed using intraluminal therapy with total drainage of the stomach, simultaneous enteral nutrition via a jejunal tube and a vacuum pressure of - 125 mmHg was applied with an electronic vacuum device. The abdominal abscess was drained via laparotomy and intra-abdominal vacuum therapy was performed with an open pore double-layered film using a vacuum pressure of - 75 mmHg. The perforation defect was not treated by operative means. Abdominal vacuum therapy ended 3 days postoperatively and the abdominal wall was closed by suture. Endoscopic vacuum therapy of the gastric perforation was terminated after 7 days and primary wound healing could then be achieved. CONCLUSION: Use of endoscopic and abdominal vacuum therapy as well as new open pore material is an innovative option for operative management.

[Endoscopic vacuum therapy of perforations and anastomotic insufficiency of the esophagus]. / Endoskopische Vakuumtherapie von Perforationen und Anastomoseninsuffizienzen des Ösophagus.

BACKGROUND: The high morbidity and mortality of esophageal defects show that the clinical challenge in the treatment of this disease still remains. An innovative method which has been developed in recent years for esophageal leakage is endoscopic vacuum therapy. OBJECTIVES: A retrospective analysis of all patients treated for esophageal perforation with endoscopic vacuum therapy in our department was carried out. METHODS: From November 2006 to October 2013 a total of 35 patients were treated with this method and of these 21 had anastomotic leakage, 7 had iatrogenic perforation due to flexible or rigid endoscopy and 7 patients had esophageal defects of various other origins. Drainage systems with an open pore polyurethane tip were placed using a standard endoscope. The vacuum drainage may be positioned either in the esophageal lumen onto the defect or through the defect into the extraluminal wound cavity. The intraluminal or intracavitary vacuum drainage is connected to an electronically controlled vacuum device and a continuous negative pressure of 125 mmHg is maintained for several days. The esophageal lumen or wound cavity collapses around the drainage resulting in intraluminal evacuation and closure of the defect. Under endoscopic monitoring the vacuum system is changed regularly until stable secondary healing of the intracorporeal wound or closure of the transmural defect is achieved. RESULTS: In 32 out of 35 patients (91.4 %) healing of defects was achieved after median treatment duration of 11 days (range 4-78 days). The postoperative anastomotic leakage healed in 20 out of 21 patients (95.2 %) after a median of 11 days (range 4-46 days) of therapy. The defects in the 7 patients who were treated for iatrogenic perforation all healed (100 %) after a median treatment time of 5 days (range 4-7 days). There was one case of a recurrent fistula 75 days after treatment. The 90-day mortality in this series of 35 patients was 5.7 %. DISCUSSION: The results of this retrospective study emphasize the increasing importance of endoscopic vacuum therapy in the current literature as an endoscopic treatment method in the management of esophageal perforation and anastomotic leakage.