VacStent GI brings revolution in life-threatening complication after upper gastrointestinal surgery

Aims Total esophagectomy and subtotal esophagectomy are a surgical technique for the treatment of carcinoma of the upper gastrointestinal tract. Leakage at the site of the anastomosis is a life-threatening complication, with repeated surgical intervention. Classic covered stents are hampered by a high rate of migration and missing functional drainage, whereas endoluminal EVT (endoscopic vacuum therapy) devices are limited by obstruction of the GI tract. The new design of the VAC Stent makes it a fully covered stent within a polyurethane sponge cylinder, allowing EVT while stent passage is still open. Among the endoscopic techniques that have been developed in recent years, VAC Stent attracts the most attention.

Methods This device combines a fully covered SEMS with an integrated EVT sponge: a silicone-coated, self-expanding, superelastic NiTi stent with a cylindrical polyurethane sponge on the outside, which is connected to a vacuum source via a catheter. A continuous negative pressure of -80 to -120 mm Hg is applied to the sponge so it cannot dislodge. VAC Stent exclude defects and maintain the patency of the esophageal lumen with the capacity of EVT to aspirate secretions, promote the formation of granulation tissue and allow oral feeding [1] [2] [3].

Results We present the results of VAC stent placement in three patients, in two different indications. A 78-year-old male with gastric cancer underwent a laparoscopic total gastrectomy with side-to-side esophagojejunostomy. On the fifth postoperative day, the drain started producing suppurative effusion. Implantation of the Vac Stent GI™ (50 mm) at the dehiscence site, with simultaneous drain removal was done. The Endo VAC was connected to a vacuum device (KCI ACELITY V.A.C. San Antonio, TX USA) with continuous suction of –120mmHg. On the seventh day after implantation, the stent was removed. A 61-year-old male with gastric cancer underwent a laparoscopic total gastrectomy and side-to-side esophagojejunostomy. Because of dehiscence of EJ anastomosis a classic totally covered stent was placed without improvement. We decide to implant VAC stent. After first implantation dehiscence was still visible, so we repeat procedure and after 7 day remove second VAC stent with complete successful healing of the dehiscence. A 69-year-old patient with esophageal cancer, developed dehiscence of the esophagogastric anastomosis after subtotal esophagectomy. In two acts a VAC was implanted 7 days apart, with complete healing of the dehiscence. All patients continued taking energy drinks and protein puddings second day after VAC implantation. An increase in body weight and normalization of albumin level was recorded, with completely healed fistulas.

Conclusions There is more evidence that VAC therapy, covering the anastomotic defect with simultaneous oral food intake might represent a revolution in managing complications after upper GI surgery. Application is an excellent example of cooperation between gastroenterologists and surgeon in the treatment ot life-threatening complications.

Conflicts of Interest

Authors do not have any conflict of interest to disclose.

• References

• 1 https://moeller-medical.com/products-solutions/vac-stent/
• 2 Klose MA, Walldorf J, Damm M, Krug S, Klose J, Ronellenfitsch U, Kleeff J, Michl P, Rosendahl J.. Treatment of esophageal leakages with the Microtech-VAC-Stent: a monocentric early experience of three cases. Ther Adv Gastrointest Endosc. 2023 16. 26317745231200312
• 3 Lange J, Kähler G, Bernhardt J, Knievel J, Dormann A, Hügle U, Eisenberger CF, Heiss MM.. The VACStent trial: combined treatment of esophageal leaks by covered stent and endoscopic vacuum therapy. Surg Endosc 2023; 37 (05): 3657-3668

Publication History

Article published online:
27 March 2025