Prophylactic negative vacuum therapy of high-risk esophageal anastomoses in pediatric patients

Jessica L. Yasuda, Wendy Jo Svetanoff, Steven J. Staffa, Benjamin Zendejas, Thomas E. Hamilton, Russell W. Jennings, Peter D. Ngo, C. Jason Smithers, Michael A. Manfredi

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Esophageal anastomoses are at risk for leak or stricture. Negative pressure vacuum-assisted closure (VAC) therapy is used to treat leak. We hypothesized that a prophylactic VAC (pEVAC) at the time of new anastomosis may lead to fewer leaks and strictures. Methods: Single center retrospective case-control study of patients undergoing high-risk esophageal anastomoses between July 2015 and January 2019. Outcomes of leak and long-term anastomotic failure (refractory stricture requiring surgery) were compared between groups. Results: Sixteen patients had a pEVAC placed during LGEA repair (N = 10) or stricture resection (N = 6). Of pEVAC cases, 3 (N = 1 Foker, N = 2 stricture resections) experienced leak (18.8%). In comparison, leak occurred in 9/41 (22%) Foker patients and in 1/20 (5%) stricture resections without pEVAC, all p > 0.05. Long-term anastomotic failure was more common in the pEVAC cohort versus controls (56.3% versus 11.5%, p < 0.001). Conclusions: Prophylactic EVAC placement does not appear to reduce leak and is associated with significantly greater odds of long-term anastomotic failure. Further device refinement could improve its potential role in prophylaxis of high-risk anastomoses, but future research is needed to better understand optimal patient selection, device design, and duration of pEVAC therapy.

Original languageEnglish (US)
Pages (from-to)944-950
Number of pages7
JournalJournal of pediatric surgery
Volume56
Issue number5
DOIs
StatePublished - May 2021
Externally publishedYes

Keywords

  • Esophageal atresia
  • Esophageal leak
  • Evac
  • Vacuum assisted closure

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

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