Abstract
Hintergrund: Nahtinsuffizienzen stellen eine gefürchtete Komplikation nach Operationen an der Speiseröhre dar, die mit hoher Morbidität und Mortalität vergesellschaftet sind. Methoden: Die Einlage komplett beschichteter Stents stellt die am häufigsten eingesetzte Methode zur Behandlung ösophagealer Leckagen dar. Eine neue endoskopische Therapiemodalität besteht mit der endoskopischen Vakuumschwammtherapie. Hierbei macht man sich die positiven Effekte des vakuumassistierten Verschlusses (Vacuum-Assisted Closure, V.A.C.), der eine etablierte Therapiemodalität zur Behandlung ausgedehnter infizierter Hautdefekte darstellt, zunutze. Durch neue Entwicklungen haben auch Clips (insbesondere der «Over-the-Scope-Clip», OTSC) wieder eine Bedeutung beim Verschluss von ösophagealen Nahtinsuffizienzen erhalten. Ergebnisse: Mit diesen endoskopischen Techniken lassen sich Nahtinsuffizienzen des Ösophagus in über 80% der Fälle erfolgreich verschließen. Schlussfolgerung: Endoskopische Techniken stellen eine geeignete Methode zum Verschluss ösophagealer Leckagen dar und konnten daher in den letzten 10 Jahren die chirurgische Revision weitestgehend verdrängen
Literatur
1.
Lee Y, Fujita H, Yamana H, Kakegawa T: Factors affecting leakage following esophageal anastomosis. Surg Today 1994;24:24–29.
2.
Faller J: Surgery for esophageal and cardia cancer in Hungary: a nationwide retrospective five-year survey. Surg Today 1996;26:368–372.
3.
Lang H, Piso P, Stukenborg C, Raab R, Jähne J: Management and results of proximal anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma. Eur J Surg Oncol 2000;26:168–171.
4.
Miller JD, Jain MK, de Gara CJ, Morgan D, Urschel JD: Effect of surgical experience on results of esophagectomy for esophageal carcinoma. J Surg Oncol 1997;65:20–21.
5.
Schubert D, Pross M, Nestler G, Ptok H, Scheidbach H, Fahlke J, Lippert H: Endoscopic treatment of mediastinal anastomotic leaks. Zentralbl Chir 2006;131:369–375.
6.
Pross M, Manger T, Reinheckel T, Mirow L, Kunz D, Lippert H: Endoscopic treatment of clinically symptomatic leaks of thoracic esophageal anastomoses. Gastrointest Endosc 2000;51:73–76.
7.
Truong S, Bohm G, Klinge U, Stumpf M, Schumpelick V: Results after endoscopic treatment of postoperative upper gastrointestinal fistulas and leaks using combined Vicryl plug and fibrin glue. Surg Endosc 2004;18:1105–1108.
8.
Rabago LR, Ventosa N, Castro JL, Marco J, Herrera N, Gea F: Endoscopic treatment of postoperative fistulas resistant to conservative management using biological fibrin glue. Endoscopy 2002;34: 632–638.
9.
Luigiano C, Ferrara F, Polifemo AM, Fabbri C, Ghersi S, Bassi M, D’Imperio N: Endoscopic closure of esophageal fistula using a novel ‘clips and loop’ method. Endoscopy 2009;41(suppl 2):E249–250.
10.
Ivekovic H, Rustemovic N, Brkic T, Opacic M, Pulanic R, Ostojic R, Vucelic B: The esophagus as a working channel: successful closure of a large Mallory-Weiss tear with clips and an endoloop. Endoscopy 2011;43(suppl 2):E170.
11.
Galizia G, Napolitano V, Castellano P, Pinto M, Zamboli A, Schettino P, Orditura M, De Vita F, Auricchio A, Mabilia A, Pezzullo A, Lieto E: The Over-The-Scope-Clip (OTSC) system is effective in the treatment of chronic esophagojejunal anastomotic leakage. J Gastrointest Surg 2012;16: 1585–1589.
12.
Sandmann M, Heike M, Faehndrich M: Application of the OTSC system for the closure of fistulas, anastomosal leakages and perforations within the gastrointestinal tract. Z Gastroenterol 2011;49: 981–985.
13.
Schubert D, Scheidbach H, Kuhn R, Wex C, Weiss G, Eder F, Lippert H, Pross M: Endoscopic treatment of thoracic esophageal anastomotic leaks by using silicone-covered, self-expanding polyester stents. Gastrointest Endosc 2005;61:891–896.
14.
Dai YY, Gretschel S, Dudeck O, Rau B, Schlag PM, Hünerbein M: Treatment of oesophageal anastomotic leaks by temporary stenting with self-expanding plastic stents. Br J Surg 2009;96:887–891.
15.
Roy-Choudhury SH, Nicholson AA, Wedgwood KR, Mannion RA, Sedman PC, Royston CM, Breen DJ: Symptomatic malignant gastroesophageal anastomotic leak: management with covered metallic esophageal stents. AJR Am J Roentgenol 2001;176:161–165.
16.
Doniec JM, Schniewind B, Kahlke V, Kremer B, Grimm H: Therapy of anastomotic leaks by means of covered self-expanding metallic stents after esophagogastrectomy. Endoscopy 2003;35:652–658.
17.
Gelbmann CM, Ratiu NL, Rath HC, Rogler G, Lock G, Scholmerich J, Kullmann F: Use of self-expandable plastic stents for the treatment of esophageal perforations and symptomatic anastomotic leaks. Endoscopy 2004;36:695–699.
18.
Hünerbein M, Stroszczynski C, Moesta KT, Schlag PM: Treatment of thoracic anastomotic leaks after esophagectomy with self-expanding plastic stents. Ann Surg 2004;240:801–807.
19.
Langer FB, Wenzl E, Prager G, Salat A, Miholic J, Mang T, Zacherl J: Management of postoperative esophageal leaks with the Polyflex self-expanding covered plastic stent. Ann Thorac Surg 2005;79: 398–403.
20.
Radecke K, Gerken G, Treichel U: Impact of a self-expanding, plastic esophageal stent on various esophageal stenoses, fistulas, and leakages: a single-center experience in 39 patients. Gastrointest Endosc 2005;61:812–818.
21.
Peters JH, Craanen ME, van der Peet DL, Cuesta MA, Mulder CJ: Self-expanding metal stents for the treatment of intrathoracic esophageal anastomotic leaks following esophagectomy. Am J Gastroenterol 2006;101:1393–1395.
22.
Kauer WK, Stein HJ, Dittler HJ, Siewert JR: Stent implantation as a treatment option in patients with thoracic anastomotic leaks after esophagectomy. Surg Endosc 2008;22:50–53.
23.
Tuebergen D, Rijcken E, Mennigen R, Hopkins AM, Senninger N, Bruewer M: Treatment of thoracic esophageal anastomotic leaks and esophageal perforations with endoluminal stents: efficacy and current limitations. J Gastrointest Surg 2008;12: 1168–1176.
24.
Wedemeyer J, Schneider A, Manns MP, Jackobs S: Endoscopic vacuum-assisted closure of upper intestinal anastomotic leaks. Gastrointest Endosc 2008;67:708–711.
25.
Wedemeyer J, Brangewitz M, Kubicka S, Jackobs S, Winkler M, Neipp M, Klempnauer J, Manns MP, Schneider AS: Management of major postsurgical gastroesophageal intrathoracic leaks with an endoscopic vacuum-assisted closure system. Gastrointest Endosc 2010;71:382–386.
26.
Loske G, Schorsch T, Müller C: Intraluminal and intracavitary vacuum therapy for esophageal leakage: a new endoscopic minimally invasive approach. Endoscopy 2011;43:540–544.
27.
Weidenhagen R, Hartl WH, Gruetzner KU, Eichhorn ME, Spelsberg F, Jauch KW: Anastomotic leakage after esophageal resection: new treatment options by endoluminal vacuum therapy. Ann Thorac Surg 2010;90:1674–1681.
28.
Ahrens M, Schulte T, Egberts J, Schafmayer C, Hampe J, Fritscher-Ravens A, Broering DC, Schniewind B: Drainage of esophageal leakage using endoscopic vacuum therapy: a prospective pilot study. Endoscopy 2010;42:693–698.
29.
Vikatmaa P, Juutilainen V, Kuukasjarvi P, Malmivaara A: Negative pressure wound therapy: a systematic review on effectiveness and safety. Eur J Vasc Endovasc Surg 2008;36:438–448.
30.
Thompson JT, Marks MW: Negative pressure wound therapy. Clin Plast Surg 2007;34:673–684.
31.
Holle G, Riedel K, von Gregory H, Gazyakan E, Raab N, Germann G: Vacuum-assisted closure therapy: current status and basic research. Unfallchirurg 2007;110:490–504.
32.
Weidenhagen R, Gruetzner KU, Wiecken T, Spelsberg F, Jauch KW: Endoscopic vacuum-assisted closure of anastomotic leakage following anterior resection of the rectum: a new method. Surg Endosc 2008;22:1818–1825.
© 2012 S. Karger AG, Basel
2012
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.
