Alfonso Lapergola, MD, Bernard Dallemagne, MD, Antonio D’urso, MD, Ludovica Guerriero, Didier Mutter, MD, PhD, FACS, Jacques Marescaux, MD, FACS, HonFRCS, HonFJSES, Silvana Perretta, MD, PhD. Department of Digestive and Endocrine Surgery, Nouvel Hôpital Civil, Strasbourg University Hospital; Institut de Recherche contre les Cancers de l’Appareil Digestif (IRCAD) – IHU, Institute of Image-Guided Surgery
In recent years several new endoscopic closure techniques and devices have been developed to manage complications of both surgical and endoscopic procedures in a less invasive yet effective way.
The Padlock clipTM (US Endoscopy) represents a novel over-the-scope clip designed to achieve a radial closure in order to improve the ability to approximate tissue allowing a solid and robust closure.
Here we share our experience using the Padlock clipTM to address a variety of acute and chronic gastrointestinal surgical complications.
The first case shows the successful closure of a persistent esophageal leak, initially treated by an esophageal fully covered stent, following an iatrogenic esophageal perforation which occurred during a hiatal hernia repair performed in another center.
The second case illustrates the use of the Padlock clipTM to close a gastro-gastric fistula, in a patient complaining of persistent abdominal pain 2 years after gastric-bypass surgery.
The third case demonstrates the application of the clip together with a vicryl plug under endoscopic and bronchoscopic control to treat a chronic tracheo-esophageal fistula developed 4 years after an Ivor-Lewis esophagectomy.
The last case presents the endoscopic rescue of an iatrogenic perforation after endoscopic balloon dilatation of a gastro-jejunal anastomosis stenosis in a patient who underwent a redo gastric-by-pass after sleeve gastrectomy failure. Here we show how the clip was used in combination with an esophageal fully covered self-expandable metal stent to secure the upper flange to prevent migration.
The Padlock clipTM is a useful, versatile, easy-to-apply endoscopic device that has been successfully used alone or in combination with other endoscopic devices, to rescue diverse surgical complications both in the acute and chronic setting, even in the presence of challenging or surgical modified anatomy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95153
Program Number: V136
Presentation Session: Flexible Endoscopy II
Presentation Type: Video