Use of a NOTES closure device for full-thickness suturing of a postoperative anastomotic esophageal leakage.
Leakages at surgical anastomoses in the gastrointestinal tract represent a challenging clinical problem. Standard therapy entails conservative or surgical revision of the anastomotic area with high morbidity and mortality up to 30 %. None of the previous endoscopic approaches, which include stenting, endoscopic clip closure, and fibrin glue injection, are sufficiently established for routine clinical use. We report a case of a 68-year-old woman with a postoperative leakage and abscess at the esophagojejunostomy. The defect was closed with two anchor-lock sutures. The patient was able to resume oral food intake 5 days later and made a full recovery with endoscopically documented mucosal healing at the site of the anastomosis. In summary, endoscopic suturing may be a promising approach for the treatment of postoperative leaks that warrants further, controlled investigation.
Hampe
J
J
Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany.
Schniewind
B
B
Both
M
M
Fritscher-Ravens
A
A
D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures; D012086:Reoperation; D013529:Surgical Wound Dehiscence / Q000601:surgery*; D053441:Suture Anchors; D013536:Suture Techniques / Q000295:instrumentation*; D014945:Wound Healing