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.
