“Rendezvous technique” for intraluminal vacuum therapy of anastomotic leakage of the jejunum
© The Author(s). 2016
Received: 22 May 2016
Accepted: 13 October 2016
Published: 18 October 2016
Anastomotic leakage (AL) is one of the most common and serious complications following visceral surgery. In recent years, endoluminal vacuum therapy has dramatically changed therapeutic options for AL, but its use has been limited to areas easily accessible by endoscope.
We describe the first use of endoluminal vacuum therapy in the small intestine employing a combined surgical and endoscopic “rendezvous technique” in which the surgeon assists the endoscopic placement of an endoluminal vacuum therapy sponge in the jejunum by means of a pullback string. This technique led to a completely closed AL after 27 days and 7 changes of the endosponge.
The combined surgical and endoscopic rendezvous technique can be useful in cases of otherwise difficult endosponge placement.
KeywordsEndosponge Anastomotic leakage
Anastomotic leakage (AL) is one of the most common and serious complications following visceral surgery. AL arising early postoperative are amenable to surgical revision, but those occurring later on are difficult to treat. In such cases, surgical revision is often not possible or only possible with major collateral damage due to the presence of intra-abdominal adhesions. In recent years, endoluminal vacuum therapy has been used for late occurring and not surgically amenable AL of the upper gastrointestinal tract (esophagus, stomach). In this procedure, an endosponge is used to treat a perforation in the esophagus or an AL without surgical revision [1, 2]. For technical reasons, however, the use of endoluminal vacuum therapy on perforations and AL has been limited to areas easily accessible by endoscope, which is not the case for AL in the small intestine.
We describe here the first use of endoluminal vacuum therapy in the small intestine employing a combined surgical and endoscopic “rendezvous technique” in which the surgeon assists the endoscopic placement in the jejunum by means of a pullback string.
Introduction of endoluminal vacuum therapy for AL located in the upper gastrointestinal tract has expanded the available therapeutic options for AL patients and greatly improved their prognosis. To date, however, this technique has been limited to AL that are easily accessible by endoscopy. The modified rendezvous technique described here enables effective treatment even in patients with endoscopically difficult or impossible to reach AL. Often, small intestinal leaks or insufficiencies of the duodenal stump are only detected when they are no longer amenable to surgical treatment. To the best of our knowledge, the literature contains only one report of a similar combined internal/external procedure and a few cases of application in the small intestine [3–5]. In that case, the defect was also successfully treated. Endoluminal vacuum therapy is superior to external drains such as “Robinson” or “Jackson Pratt” drains in this section of the intestine because it can continuously remove the high daily volume of bile, pancreatic fluid, and intestinal fluid passing through, leading to faster healing. It may also lessen the risk of developing an undrained “abscess.” The major limitation of this technique is the need to admit the patient to the ICU ward during the procedure as leaking or technical errors in the system must be detected rapidly to avoid compromising the therapeutic goal. A second disadvantage is that the pullback string by its nature creates a fistula between the abdominal wall and jejunum. But by the time, the leakage site had healed to a small channel of approximately 3 mm in diameter, comparable to the fistula left after removal of a jejunal feeding tube and finally closed spontaneously after completing the endoluminal vacuum therapy.
In conclusion, our innovative combined intraluminal and extraluminal approach for vacuum therapy using a modified rendezvous technique is an effective way to manage, otherwise difficult to access AL in the small intestine.
We thank Miss Stevenson for the language editing.
All authors prepared, reviewed, and gave critical input into each stage of the manuscript, such as data collection, performing the analyses, and interpreting the results. All authors read and approved the final manuscript.
The authors declare that they have no competing interests.
Consent for publication
Written informed consent was obtained from the patient for the publication of this report and any accompanying images.
There was no research foundation for this study.
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- Heits N, Stapel L, Reichert B, et al. Endoscopic endoluminal vacuum therapy in esophageal perforation. Ann Thorac Surg. 2014;97:1029–35.View ArticlePubMedGoogle Scholar
- Seyfried F, Reimer S, Miras AD, et al. Successful treatment of a gastric leak after bariatric surgery using endoluminal vacuum therapy. Endoscopy. 2013. doi:10.1055/s-0033-1344569.PubMedGoogle Scholar
- Glatz T, Fischer A, Hoeppner J, Thimme R, Walker C, Richter-Schrag HJ. Vacuum sponge therapy using the pull-through technique via a percutaneous endoscopic gastrostomy to treat iatrogenic duodenal perforation. Endoscopy. 2015. doi:10.1055/s-0034-1393369.PubMedGoogle Scholar
- Mennigen R, Senninger N, Laukoetter MG. Novel treatment options for perforations of the upper gastrointestinal tract: endoscopic vacuum therapy and over-the-scope clips. World J Gastroenterol. 2014;20:7767–76.View ArticlePubMedPubMed CentralGoogle Scholar
- Loske G, et al. Intraluminal endoscopic vacuum therapy following ischemia of the blind end of a jejunal Roux-en-Y loop…. Endoscopy. 2014;46:E575–6.View ArticlePubMedGoogle Scholar