A Case Series and Technical Note on Endoluminal Vacuum Therapy via Pull-Through Technique for Leakage after Metabolic Bariatric Surgery

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BACKGROUND: ) is an effective treatment for leaks following metabolic-bariatric surgery (MBS), used for staple line- or anastomotic leakage. While EVT is conventionally placed using an overtube, the pull-through technique is a convenient alternative for hardly accessible dehiscence or large wound cavity, allowing precise sponge placement for optimal drainage. This analysis provides a technical note and evaluates pull-through EVT's efficacy in MBS patients. MATERIAL & METHODS: All patients treated for leaks after MBS with EVT pull-through technique between 01/2018 and 06/2025 at the Department of General Surgery, Medical University of Vienna (MUV), were included in this retrospective analysis. Statistical analyses were performed descriptively. RESULTS: 7 patients were treated with EVT via pull-through technique. In 5/7 cases (71.4%), index surgery was a primary MBS and acute leaks occurred in 6/7 cases (85.7%). All patients received surgical reintervention, targeted drainage and EVT (7/7; 100%). Self-expanding metal stent was used in 4/7 cases (57.1%) additionally. EVT was changed 9.6 times (3-33) with EVT duration of 30.8 days (11-97). No severe device-related complications were observed. Successful leak closure with EVT was achieved in 85.7%. CONCLUSION: EVT via pull-through technique is effective and feasible for managing leaks after MBS when targeted drainage is available. It allows precise EVT placement and enhanced tissue healing, potentially reducing necessity for further reoperation in critically ill patients.

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