A modified endoluminal vacuum therapy system for salvage management of recurrent anastomotic leak after revisional bariatric surgery.

Endoluminal vacuum therapy (EVT) has emerged as a minimally invasive and effective approach for the management of gastrointestinal anastomotic leaks, particularly in complex or refractory cases. Meta-analyses report pooled clinical success rates of ~80%-85%, with evidence suggesting higher success compared with self-expanding metal stents. We report the case of a 55-year-old female with a history of sleeve gastrectomy who underwent revisional bariatric surgery complicated by multiple anastomotic failures, open abdomen management, and recurrent gastrojejunal leakage. After failure of repeated surgical interventions, EndoVAC therapy was initiated as salvage treatment. A manually assembled system using a white open-pore polyurethane foam sponge was endoscopically placed and exchanged over 22 days, achieving complete clinical and endoscopic resolution without further surgical intervention. This case highlights the role of EndoVAC as an effective salvage strategy in complex postoperative leaks following revisional bariatric surgery.