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Anastomotic leakage is a major complication of colorectal surgery. Its treatment depends on the severity of the leakage. If the patient has generalized peritonitis with sepsis, emergency surgery is mandatory.1 However, if the patient is clinically less affected, other approaches can be explored. Several options are available, such as endoluminal vacuum therapy, transanastomotic pigtails stents, or endoscopic suturing.1–3 The literature comparing these approaches is scarce. However, in a retrospective study conducted by Thiruvengadam et al, patients receiving combined therapy (endoscopic drainage with local closure) presented the best clinical success rates.3
In this video article, we show conservative management with combined therapy (pigtail drainage with endoscopic suturing) of an anastomotic leakage after interval debulking surgery. As shown in this video, small anastomotic defects can be safely managed by drainage and late endoscopic suturing with a flexible colonoscope.
The Apollo Overstitch endoscopic suturing device is mounted on the tip of the double channel therapeutic endoscope. The device contains a needle driver, which moves in an arc-like fashion, and an anchor exchange catheter. The device is connected to a large handle, which is attached near the endoscope controls. The suture is first mounted onto the anchor exchange catheter and passed through the operating channel. The anchor is then transferred to the needle driver, and suturing is performed by transferring the anchor back and forth between the needle driver and the anchor exchange catheter. When suturing is complete, a release button on the anchor exchange catheter releases the anchor. The suture is threaded onto a cinch device, which is then passed through the operating channel to both secure and cut the suture. In this fashion, the Overstitch device allows interrupted or continuous sutures to be placed without needing to remove the device. The device itself can be reloaded multiple times with new needles without removing the endoscope.4
Small anastomotic leakage can be managed by minimally invasive treatment using endoscopic techniques, such as the Overstitch suturing device.
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Footnotes
Twitter @BoriaFelix
Contributors FB was responsible for video editing and narrating. The other authors contributed to the surgery and approved the final version of the video. FB is responsible for the overall content as guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.