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Improvement of Esophageal Anastomotic Leak by Vacuum-assisted Closure in Three Cases with Gastric Cancer.

This case report presents three consecutive patients who developed esophageal anastomotic leak after gastric cancer surgery and were treated by the two-way vacuum-assisted closure with open abdomen technique in addition to endoscopic stent application (ESA). Esophageal anastomotic leak follow-up was performed by fluoroscopic fistulography. Total parenteral nutrition was given until cessation of leak. All applications of the two-way vacuum-assisted closure were carried out with a vacuum-assisted closure management system. In case of the improvement of the esophageal anastomotic leak detected by fluoroscopy, the two-way vacuum-assisted closure application was terminated. The subcutaneous layer was bilaterally dissected from the fascial layer of the anterior wall of the abdomen, and the abdominal skin was closed without tension. The combination of ESA and the two-way vacuum-assisted closure technique should be suggested in case of severe abdominal sepsis in patients with an esophageal anastomotic leak.