ENDOSCOPIC SUTURING IS FEASIBLE FOR TREATMENT OF LOW COLORECTAL ANASTOMOTIC LEAK – EXPERIMENTAL STUDY

Aims:

The aim of our study was to assess the feasibility of endoscopic repair of anastomotic leak on animal model. Secondary aim was to evaluate whether this technique prevents intraabdominal sepsis.

Methods:

Model of low colorectal anastomotic leak was introduced in 28 male pigs. Laparoscopic low anterior resection was performed and the anastomosis created with 28 mm circular stapler after removing half of the staples.

Fourteen pigs had an endoscopic anastomotic repair with OverStitchTM 2 days later. A double-channel endoscope was introduced and defect closed with 2/0 prolene and secured with original knotless fixation. Three-grade scale (I – closed completely, II – closed with visible gaps, III – closure not possible) was used to assess the completion of closure. The signs of intraabdominal septic complications – IASC and anastomotic healing including burst test were assessed after animals being sacrificed on 9th postoperative day. Fourteen animals with no treatment were included in control group. Chi square test was used to compare both groups.

Results:

Endoscopic closure was technically possible in all 14 cases (gr. I – 11, gr. II – 3 and gr. III – 0) with mean procedure time of 31 (19 – 70)min. Two animals from suture group died due to peritonitis on 8th and 9th postoperative day. Overall IASC rate was however significantly lower compared to the control – 5/14 vs. 11/14 (p = 0,022). The autopsy confirmed healed anastomosis with no visible defect in 10/14 case in Apollo vs. 2/14 in control group (p = 0,0023). The burst test performed in 10 healed Apollo cases confirmed sufficient closure with mean pressure of 200 (80 – 300) mmHg.

Conclusions:

OverStitchTM endoscopic suturing is technically feasible for repair of low colorectal anastomotic leak. This technique reduced the rate of intraabdominal septic complications.

Supported by AZV 16 – 31806A, MO 1012.