# Placing vacuum sponges in esophageal anastomotic leaks — how we do it

## TL;DR

A new technique for placing vacuum sponges in esophageal leaks is shown to be safe and effective, avoiding complications seen with standard methods.

## Contribution

The paper introduces a 'piggyback' technique for vacuum sponge placement, improving on standard insertion methods in esophageal surgery.

## Key findings

- The piggyback technique was used successfully in 56 sponge insertions across seven patients with no intraprocedural complications.
- All patients except one (who died unrelated) healed and were discharged, with three long-term strictures successfully treated by dilatation.

## Abstract

Endoluminal vacuum sponge therapy has dramatically improved the treatment of anastomotic leaks in esophageal surgery. However, the blind insertion of vacuum sponge kits like Eso-Sponge® via an overtube and a pusher can be technically difficult.

We therefore insert our sponges under direct visual control by a nonstandard “piggyback” technique that was initially developed for the self-made sponge systems preceding these commercially available kits.

Using this technique, we inserted or changed 56 Eso-Sponges® in seven patients between 2018 and 2023. Apart from one secondary sponge dislocation, no intraprocedural complications were encountered. One patient died due to unrelated reasons. In all others, the defects healed and they were dismissed from the hospital. Long-term follow-up showed three strictures that were successfully treated by dilatation.

We conclude that sponge placement via piggyback technique is a fast, safe, and successful alternative to the standard method of insertion.