Gabriel D Lang, MD, Faris M Murad. Washington University
Post-operative complications such as anastomotic leaks and staple line dehiscence are associated with significant morbidity and mortality. Previously, endoscopy was used for the diagnosis and treatment of only small leaks and fistulae. Currently, novel therapeutic techniques can treat a wide variety of post-surgical complications. Here, we present a case of a large staple line dehiscence with leak managed by endoscopic suturing.
A 72-year-old male with a history of reflux disease and open fundoplication in 1980 and ventral hernia repair with mesh in 2009 presents with reflux and evidence of a slipped fundoplication. The patient underwent a Nissen takedown and anterior Dor fundoplication. The surgery was complicated by a post-operative leak. The patient underwent an upper endoscopy and a large 4 cm by 3 cm staple line dehiscence was noted. Endoscopic suturing was performed, but unfortunately the mucosal defect persisted. A second endoscopic suturing procedure was performed with complete closure of the large defect and radiologic resolution of the leak.
Endoscopic suturing allows for closure of fistulas and anastomotic leaks. It is a minimally invasive approach that may spare patients from re-operations associated with a high morbidity and mortality. Large mucosal defects may require multiple procedures for complete closure.