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A case of a 33 year-old woman with two mural defects after sleeve gastrectomy for obesity (weight 133 kg) is presented. Endoscopy procedure after two weeks of surgery demonstrated two anastomotic leakages: one located at the upper portion of the sleeve (size 15 x 35 mm) and a smaller one at the bottom (size 10 x 15 mm).
Both defects were treated with endoscopic vacuum therapy (EVT), one intracavitary and the other endoluminal. EVT works by applying continuous, controlled negative pressure at the defect with the use of an endoscopically placed polyurethane sponge connected to an electronic vacuum device (-125 mmHg). Placement and removal of the EVT system was endoscopically performed with general anesthesia. A polyurethane foam sponge had been adapted to the particular wound size as estimated by the endoscopist. The defects required 6 and 2 sponge exchanges (upper and lower wounds respectively) over 4 weeks and complete resolution was achieved. No adverse events occurred and there has been no recurrence of the wounds one after the procedure.
EVT has been shown to be feasible, safe, and effective to repair gastrointestinal mural defects which are associated with significant morbidity and mortality in these patients.