Endoscopic heliX tacking system for the Management of colonic Anastomotic dehiscence (X-MAN) after a laparoscopic left colectomy

Aims The endoscopic helix tacking system is increasingly used to treat mucosal defects, particularly following endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) [1]. Here, we aim to demonstrate the feasibility of using this tacking system to manage an anastomotic dehiscence after oncologic laparoscopic left colectomy.

Methods Anastomotic dehiscence is defined as the separation of sutures occurring after colectomy [2]. When dehiscence leads to bowel leakage, it can result in pelvic abscesses, peritonitis, or sepsis [3]. The current standard of care includes a diverting colostomy or ileostomy along with drainage of the surgical site infection. In recent years, however, minimally invasive endoscopic approaches, such as endoluminal vacuum therapy (EVT), have shown effectiveness in managing colonic dehiscence [2].

Results We present the case of a 69-year-old male patient who underwent laparoscopic left colectomy with an end-to-end colorectal anastomosis, performed 18 cm from the anal margin, to treat colonic adenocarcinoma. Within two months, he developed an anastomotic dehiscence affecting approximately a quarter of the anastomosis (approximately 15 mm), connected to a small cavity measuring 20 mm in diameter. The patient initially received endoluminal vacuum therapy (EVT), which reduced the orifice size from 20 mm to 10 mm within two weeks. However, complete closure of the fistulising orifice was ultimately achieved with the use of an endoscopic helix tacking system. Closure was accomplished by placing four tacks around the defect in a "Z" pattern, pulling the thread attached to the tacks, and securing the suture with a cinch device to lock the suture and cut the thread. Six-week follow-up confirmed successful endoscopic closure using X-MAN (HeliX tacking system for the Management of colonic ANastomotic dehiscence).

Conclusions This case demonstrates the safe and effective management of a post-colectomy anastomotic dehiscence using the endoscopic helix tacking system or X-MAN.

 

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Conflicts of Interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Daams F. et al. Treatment of colorectal anastomotic leakage: results of a questionnaire amongst members of the Dutch Society of Gastrointestinal Surgery. Dig Surg 2012; 29: 516-21
• 2 Cwaliński J. et al. Dehiscence of colorectal anastomosis treated with non invasive procedures. Wideochir Inne Tech Maloinwazyjne 2023; 18 (1): 128-134
• 3 Mohapatra S. et al. Follow-up outcomes of mucosal defect closures after endoscopic resection using a helix tacking system and endoclips. VideoGIE 2022; 11 7 (7) 268-272

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025