An adapted version of endoscopic vacuum therapy (E-VAC), termed "low-cost VAC," is
made using gauze or an open-pore sponge covered with perforated sterile plastic. We
present a case series of five patients with various presentations of postoperative
leaks and fistulas treated with the "low-cost VAC" method: 1) A 67-year-old female
with squamous cell carcinoma underwent esophagectomy. Postoperatively, she developed
a complex fistula (esophagus-pleuro-mediastinal-cutaneous). E-VAC therapy required
five placements and replacements, leading to complete closure after 50 days. A complication
of esophageal stenosis was resolved with balloon dilation. 2) A 77-year-old male with
esophageal adenocarcinoma had esophagogastric anastomosis dehiscence. A mega-stent
and E-VAC device were placed, resulting in successful closure after 75 days. 3) A
60-year-old female experienced extensive gastric suture dehiscence after esophagectomy
for squamous cell carcinoma. E-VAC therapy achieved closure with two placements in
46 days. 4) A 61-year-old male with gastric adenocarcinoma had esophageal-jejunal
anastomosis dehiscence. E-VAC therapy closed the defect with one placement in 15 days.
5) A 59-year-old male with gastric neuroendocrine tumors underwent total gastrectomy
and developed multiple esophageal-jejunal anastomosis dehiscences. E-VAC therapy closed
the defects with two placements over 30 days [1].
This technique is feasible, cost-effective, and readily available, providing results
comparable to other drainage systems. It serves as a validated option where access
to commercial devices is limited.
