Simultaneous Endoluminal Wound Vacuum and Stent Therapy for Large Esophageal Leaks After Esophagectomy

Background: Anastomotic leaks from esophageal operations are serious life-threatening medical conditions that traditionally require invasive surgery. In this study, we discuss the outcomes of 3 patients who received minimally invasive simultaneous endoluminal wound vacuum therapy and an esophageal stent (sEV+S) treatment for uncontained esophageal leaks into the pleural space after esophagectomy. Methods: Three patients received sEV+S placement between 2016 and 2024. In this technique, a black sponge sutured to the end of a drain is placed endoscopically into the leak cavity. An esophageal stent is then centered around the leak site. Results: Patients were 54 to 71 years old. All 3 patients were men with esophageal cancer who underwent esophagectomy. The sEV+S placement was performed 2, 10, and 12 times. The total number of endoscopic procedures after the discovery of the leak was 3, 29, and 13. Length of time from leak to resolution was 16, 102, and 88 days. Hospital stay was 46, 113, and 105 days. All patients eventually returned to an oral diet (2 patients at discharge and 1 patient 23 days after discharge). A tracheoesophageal fistula developed in 1 patient requiring esophageal diversion with intercostal muscle flap repair, followed by eventual supercharged jejunal interposition graft reconstruction. Two patients were successfully treated with sEV+S placement. No patients required readmission, and no deaths occurred due to the procedures. Conclusions: We demonstrate that sEV+S treatment can successfully treat large uncontained esophageal leaks after esophagectomy.