PTH-068 Endoscopic closure of anterior resection anastomotic dehiscence using padlock clips

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Abstract

Introduction

Anastomotic leakage is one of the serious complications after anterior resection. The risk of colonic anastomotic leak after anterior resection has been reported to be as high as 23% in some published series. Herein, we present a case of successful endoscopic closure of anastomotic dehiscence using Padlock clipping system, which was used alongside the drainage of pelvic collection.

Method

43 days after developing anastomotic dehiscence post anterior resection, endoscopic Padlock clips were used to successfully close a 2 cm full thickness defect.

Results

73 years old male patient underwent laparoscopic anterior resection operation for moderately differentiated recto-sigmoid adenocarcinoma. He developed colonic anastomosis dehiscence on day 5 post-operatively. Emergency laparotomy was performed where drains were inserted with ileostomy formation while through-the-scope endoscopic clips deployed intraoperatively by the surgical team, were unable to successfully close the anastomotic defect. Patient was given parenteral nutrition post-procedure.

Results

Two weeks later, faeculent fluid was noted in one of the drains, which suggested on-going leak. Repeat scan showed persistent extra-luminal leakage of the contrast with collection.

Results

A flexible sigmoidoscopy was performed which identified a large 2 cm anastomotic site defect. This was then closed by the deployment of three Padlock clips along with three through-the-scope Resolution clips.

Conclusion

Traditionally, surgical ‘divert and drain’ technique has been the mainstay of treatment for anastomotic leakage. Whereas endoscopic clips have been used successfully for the closure of anastomotic leaks, this case highlights that the Padlock system can be used successfully to close a chronic full thickness defect.

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