Ryan M Juza, MD, Karima Fitzgerald, MD, Eric M Pauli, MD. Penn State Hershey Medical Center
Background: Gastrointestinal leak is a serious complication following abdominal surgery. Consequences of persistent leak may necessitate formal surgical intervention in a hostile abdomen. In select situations, we have utilized natural orifice transluminal endoscopic surgery (NOTES) methods to enter the abdominal cavity and place/reposition drains under direct endoscopic visualization as part of our comprehensive endoscopic leak management program. In this video, we demonstrate a Transluminal Endoscopic Drain Repositioning Technique.
Methods and Procedures: In this video we present the case of a 60 year old female who had sigmoid perforation following a screening colonoscopy. She had multiple previous laparotomies but had persistent complications of a gastric leak. Upper endoscopy was performed and transluminal access was obtained via the leak site and carbon dioxide insufflation was used to surveille the peritoneal cavity and irrigate and suction debris. Previously placed surgical drains were located endoscopically and fluoroscopically and repositioned to ensure better drainage. The gastric leak was then endoscopically clipped to prevent further contamination.
Results: The patient had symptomatic improvement after drain repositioning and required no further surgical interventions. She had a small persistent gastric leak that was contained by the drains and resolved after repeat endoscopic clipping.
Conclusion: Intraabdominal drains are an essential element in the management of gastrointestinal leaks, but are not always optimally positioned. Transluminal endoscopic drain repositioning via a gastrointestinal defect is a viable option to avoid surgical intervention in an otherwise hostile field.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88120
Program Number: V124
Presentation Session: Friday Exhibit Hall Theater (Non CME)
Presentation Type: EHVideo