Endoscopic Vacuum Therapy for Upper GI Injuries in Combat Trauma

How can a difficult esophageal or duodenal defect be managed when another major operation carries substantial risk? This session presents the experience of the minimally invasive surgery and endoscopy team at the Main Military Clinical Hospital using endoscopic vacuum therapy in wounded patients.

The lecture moves from fundamentals to bedside technique: intraluminal versus intracavitary placement, preparation of a custom vacuum sponge, drainage setup, endoscopic delivery, wound assessment, contrast studies, debridement, and serial replacement. Particular attention is given to details that determine whether the method actually works — reliable sponge fixation, maintaining effective sealing, adapting negative pressure to tissue response, and controlling enteric secretions.

Three complex combat-trauma cases demonstrate the evolution of esophageal and duodenal defects over repeated EndoVAC sessions, including a challenging duodenal injury managed alongside enteral feeding and nasobiliary drainage. The discussion also covers when to initiate therapy, typical replacement intervals, pressure escalation based on granulation, situations where intracavitary placement is preferable, and why loss of vacuum can signal treatment failure.

The Q&A adds clinically important cautions: bleeding from excessive negative pressure, limitations in patients with difficult access or severe systemic condition, and the need to reassess the strategy early when granulation and defect reduction are not occurring. A detailed, experience-based look at a minimally invasive option for some of the most difficult upper GI injuries encountered in trauma surgery.