VAC-Stent as salvage therapy after failed surgical repair and self-expandable metal stent treatment in esophageal perforation.

Esophageal perforation is a life-threatening condition requiring prompt and individualized management. Although surgical repair remains an established treatment option, endoscopic therapies have increasingly gained a role in selected patients. We report the case of a patient who developed an esophageal perforation following Nissen fundoplication. Emergency surgical repair was initially performed, but persistent leakage was subsequently observed. A self-expandable metal stent (SEMS) was then placed; however, the fistula persisted despite this treatment. As both surgical and conventional endoscopic approaches had failed, endoscopic vacuum therapy combined with an esophageal stent (VAC-Stent) was used as salvage therapy. The VAC-Stent provided simultaneous drainage of the extraluminal cavity and coverage of the esophageal defect. Serial endoscopic assessment and device exchanges resulted in progressive cavity resolution and complete closure of the perforation. The patient resumed oral intake without recurrent leakage, dysphagia, or esophageal stenosis. More than one year after treatment, the patient remains asymptomatic with a good quality of life. This case highlights the potential role of VAC-Stent therapy as a minimally invasive salvage option for persistent esophageal perforation after failure of both surgical repair and SEMS treatment.