Effects of Endoluminal Vacuum Sponge Therapy on the Perfusion of Gastric Conduit in a Porcine Model for Esophagectomy

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2024 Jan 5

PMID 38180542

Authors

Eleni Amelia Felinska

Alexander Studier-Fischer

Berkin Ozdemir

Estelle Willuth

Philipp Anthony Wise

Beat Muller-Stich

Felix Nickel

Affiliations

Soon will be listed here.

Abstract

Background: After esophagectomy, the postoperative rate of anastomotic leakage is up to 30% and is the main driver of postoperative morbidity. Contemporary management includes endoluminal vacuum sponge therapy (EndoVAC) with good success rates. Vacuum therapy improves tissue perfusion in superficial wounds, but this has not been shown for gastric conduits. This study aimed to assess gastric conduit perfusion with EndoVAC in a porcine model for esophagectomy.

Material And Methods: A porcine model (n = 18) was used with gastric conduit formation and induction of ischemia at the cranial end of the gastric conduit with measurement of tissue perfusion over time. In three experimental groups EndoVAC therapy was then used in the gastric conduit (- 40, - 125, and - 200 mmHg). Changes in tissue perfusion and tissue edema were assessed using hyperspectral imaging. The study was approved by local authorities (Project License G-333/19, G-67/22).

Results: Induction of ischemia led to significant reduction of tissue oxygenation from 65.1 ± 2.5% to 44.7 ± 5.5% (p < 0.01). After EndoVAC therapy with - 125 mmHg a significant increase in tissue oxygenation to 61.9 ± 5.5% was seen after 60 min and stayed stable after 120 min (62.9 ± 9.4%, p < 0.01 vs tissue ischemia). A similar improvement was seen with EndoVAC therapy at - 200 mmHg. A nonsignificant increase in oxygenation levels was also seen after therapy with - 40 mmHg, from 46.3 ± 3.4% to 52.5 ± 4.3% and 53.9 ± 8.1% after 60 and 120 min respectively (p > 0.05). An increase in tissue edema was observed after 60 and 120 min of EndoVAC therapy with - 200 mmHg but not with - 40 and - 125 mmHg.

Conclusions: EndoVAC therapy with a pressure of - 125 mmHg significantly increased tissue perfusion of ischemic gastric conduit. With better understanding of underlying physiology the optimal use of EndoVAC therapy can be determined including a possible preemptive use for gastric conduits with impaired arterial perfusion or venous congestion.

Citing Articles

The Impact of EndoVAC in Addressing Post-Esophagectomy Anastomotic Leak in Esophageal Cancer Management.

Papadakos S, Argyrou A, Katsaros I, Lekakis V, Mpouga G, Vergadis C J Clin Med. 2024; 13(23).

PMID: 39685572 PMC: 11642085. DOI: 10.3390/jcm13237113.

References

Mencio M, Ontiveros E, Burdick J, Leeds S . Use of a novel technique to manage gastrointestinal leaks with endoluminal negative pressure: a single institution experience. Surg Endosc. 2018; 32(7):3349-3356. DOI: 10.1007/s00464-018-6055-x. View

Weidenhagen R, Hartl W, Gruetzner K, Eichhorn M, Spelsberg F, Jauch K . Anastomotic leakage after esophageal resection: new treatment options by endoluminal vacuum therapy. Ann Thorac Surg. 2010; 90(5):1674-81. DOI: 10.1016/j.athoracsur.2010.07.007. View

Grimminger P, Goense L, Gockel I, Bergeat D, Bertheuil N, Chandramohan S . Diagnosis, assessment, and management of surgical complications following esophagectomy. Ann N Y Acad Sci. 2018; 1434(1):254-273. DOI: 10.1111/nyas.13920. View

Petzina R, Gustafsson L, Mokhtari A, Ingemansson R, Malmsjo M . Effect of vacuum-assisted closure on blood flow in the peristernal thoracic wall after internal mammary artery harvesting. Eur J Cardiothorac Surg. 2006; 30(1):85-9. DOI: 10.1016/j.ejcts.2006.04.009. View

Studier-Fischer A, Seidlitz S, Sellner J, Bressan M, Ozdemir B, Ayala L . HeiPorSPECTRAL - the Heidelberg Porcine HyperSPECTRAL Imaging Dataset of 20 Physiological Organs. Sci Data. 2023; 10(1):414. PMC: 10290660. DOI: 10.1038/s41597-023-02315-8. View

Pournaras D, Hardwick R, Safranek P, Sujendran V, Bennett J, Macaulay G . Endoluminal Vacuum Therapy (E-Vac): A Treatment Option in Oesophagogastric Surgery. World J Surg. 2018; 42(8):2507-2511. PMC: 6060786. DOI: 10.1007/s00268-018-4463-7. View

Ooi G, Burton P, Packiyanathan A, Loh D, Chen R, Shaw K . Indications and efficacy of endoscopic vacuum-assisted closure therapy for upper gastrointestinal perforations. ANZ J Surg. 2016; 88(4):E257-E263. DOI: 10.1111/ans.13837. View

Morykwas M, Argenta L, McGuirt W . Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg. 1997; 38(6):553-62. DOI: 10.1097/00000637-199706000-00001. View

Bundred J, Hollis A, Evans R, Hodson J, Whiting J, Griffiths E . Impact of postoperative complications on survival after oesophagectomy for oesophageal cancer. BJS Open. 2020; 4(3):405-415. PMC: 7260404. DOI: 10.1002/bjs5.50264. View

10.

Nickel F, Studier-Fischer A, Ozdemir B, Odenthal J, Muller L, Knoedler S . Optimization of anastomotic technique and gastric conduit perfusion with hyperspectral imaging and machine learning in an experimental model for minimally invasive esophagectomy. Eur J Surg Oncol. 2023; 51(1):106908. DOI: 10.1016/j.ejso.2023.04.007. View

11.

Manfredi M, Clark S, Staffa S, Ngo P, Smithers C, Hamilton T . Endoscopic Esophageal Vacuum Therapy: A Novel Therapy for Esophageal Perforations in Pediatric Patients. J Pediatr Gastroenterol Nutr. 2018; 67(6):706-712. DOI: 10.1097/MPG.0000000000002073. View

12.

Wackenfors A, Gustafsson R, Sjogren J, Algotsson L, Ingemansson R, Malmsjo M . Blood flow responses in the peristernal thoracic wall during vacuum-assisted closure therapy. Ann Thorac Surg. 2005; 79(5):1724-30. DOI: 10.1016/j.athoracsur.2004.10.053. View

13.

Scott R, Ritter L, Shada A, Feldman S, Kleiner D . Endoluminal Vacuum Therapy for Ivor Lewis Anastomotic Leaks: A Pilot Study in a Swine Model. Clin Transl Sci. 2016; 10(1):35-41. PMC: 5351007. DOI: 10.1111/cts.12427. View

14.

Mengardo V, Pucetti F, Mc Cormack O, Chaudry A, Allum W . The impact of obesity on esophagectomy: a meta-analysis. Dis Esophagus. 2018; 31(6). DOI: 10.1093/dote/dox149. View

15.

Ichioka S, Watanabe H, Sekiya N, Shibata M, Nakatsuka T . A technique to visualize wound bed microcirculation and the acute effect of negative pressure. Wound Repair Regen. 2008; 16(3):460-5. DOI: 10.1111/j.1524-475X.2008.00390.x. View

16.

Schorsch T, Muller C, Loske G . [Endoscopic vacuum therapy of perforations and anastomotic insufficiency of the esophagus]. Chirurg. 2014; 85(12):1081-93. DOI: 10.1007/s00104-014-2764-4. View

17.

Kamarajah S, Lin A, Tharmaraja T, Bharwada Y, Bundred J, Nepogodiev D . Risk factors and outcomes associated with anastomotic leaks following esophagectomy: a systematic review and meta-analysis. Dis Esophagus. 2020; 33(3). DOI: 10.1093/dote/doz089. View

18.

Scognamiglio P, Reeh M, Karstens K, Bellon E, Kantowski M, Schon G . Endoscopic vacuum therapy versus stenting for postoperative esophago-enteric anastomotic leakage: systematic review and meta-analysis. Endoscopy. 2020; 52(8):632-642. DOI: 10.1055/a-1149-1741. View

19.

Studier-Fischer A, Seidlitz S, Sellner J, Ozdemir B, Wiesenfarth M, Ayala L . Spectral organ fingerprints for machine learning-based intraoperative tissue classification with hyperspectral imaging in a porcine model. Sci Rep. 2022; 12(1):11028. PMC: 9247052. DOI: 10.1038/s41598-022-15040-w. View

20.

Kamolz L, Andel H, Haslik W, Winter W, Meissl G, Frey M . Use of subatmospheric pressure therapy to prevent burn wound progression in human: first experiences. Burns. 2004; 30(3):253-8. DOI: 10.1016/j.burns.2003.12.003. View