Endoluminal wound vacuum therapy for gastrointestinal leaks: current state and future directions

Anastomotic leaks after gastrointestinal (GI) and oropharyngeal surgery are some of the most dreaded surgical complications, feared by both surgeons and patients alike. In the past, these catastrophic events were almost always addressed with emergent and often complex surgery which typically consisted of a combination of primary repair, diversion, and/or wide drainage. This approach often inadvertently added to the morbidity and mortality, as well as lengthened an already prolonged recovery. With advancement of flexible endoscopy, new modalities are being developed with the goal of simplifying treatment and improving outcomes. Among those is endoluminal vacuum (EVAC) therapy. The goal of this novel therapy is to aid closure of endoscopically approachable leaks, perforations, and injuries; as well as to divert GI contents and prevent septic complications. This is a versatile technique that can safely and effectively manage complicated anastomotic leaks and injuries from the oropharynx to the rectum; potentially avoiding high-risk surgical salvage. In this report, we review the available literature, reference our technique, and present our local data. We demonstrate high rates of defect closure both in the literature and at our institution which confirm that EVAC therapy should be considered a primary treatment option for endoscopically accessible GI tract perforations or leaks.