PS01.086: TRANSGASTRIC VACUUM DRAINAGE FOR OESOPHAGEAL PERFORATIONS: A SIMPLE TECHNIQUE FOR A COMPLEX PROBLEM.

Background We present an updated case series of patients treated with a novel Transgastric (TG) drainage technique, previously published by the senior author in 2008 [Ref], which has now been used in 6 hospitals across United Kingdom and Ireland. The technique establishes vacuum drainage of the lumen of the injured oesophagus whilst maintaining its patency, effectively exteriorizing complex oesophageal perforations to allow healing. Methods Patients presenting with Boerhaave or iatrogenic rupture, undergo an initial decontamination of the chest with drainage as required. A 32–36 Fr Chest drain is inserted in a PEG guided technique, where the proximal end of the drain is positioned 5 cm above the perforation site within the oesophagus, whilst the distal end is pulled out through the stomach and abdominal wall. Continuous low-pressure suction at -10 cm water is applied. Patients continue to drink water. Further intervention is not required until the leak has healed and the drain removed. Results We have used this technique in 20 patients in our institution (3 iatrogenic perforations, 17 Boerhaave), with a median age of 72 (range; 55–85). Perforation length ranged from 1–15 cms. Three cases were performed after stenting failed to control the leak. Pleural decontamination required thoracotomy (n = 12), VATS (n = 2); in 6 cases, no pleural decontamination was required. There were four in-hospital deaths. Median duration from surgery to removal of TG drain was 31 days (range; 10 - 71). Two patients required post discharge dilatation for stricture and are currently asymptomatic. Conclusion TG drainage in effect exteriorizes the oesophageal lumen at the site of oesophageal perforation, encouraging the perforated edges to appose and allow healing by secondary intention. Mediastinal sepsis drains through the transgastric drain (on suction) and intercostal drains placed at decontamination (off suction). Patients tolerate it well, drinking while their perforation heals, avoiding nasogastric intubation. [Ref] Berrisford RG, Krishnadas R, Froeschle P, Wajed S. European Journal of Cardiothoracic Surgery 33(2008):742–744. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]