A helix tacking system for the management of colonic anastomotic dehiscence, after a laparoscopic left colectomy

Abstract

Figures

Schematic illustration of the helix tacking system showing a sequential deployment of four helix tacks around a mucosal lesion: a Placement of four tacks around the defect in a “Z” pattern. b Transmural section of a mucosal defect showing the deployment of helix tacks around a mucosal lesion. A, adventitia; M, mucosa; Mm, muscularis mucosa; Mp, muscularis propria; SM, submucosa.

a Closure was accomplished by placing four tacks around the defect in a “Z” pattern. b Securing the suture with a cinch device to lock the suture and cut the thread. c Follow-up at 6 weeks confirmed successful endoscopic closure using the X-MAN (heliX tacking system for the Management of colonic ANastomotic dehiscence).

Full text

The endoscopic helix tacking system is increasingly used to treat mucosal defects, particularly following endoscopic submucosal dissection or endoscopic mucosal resection 1 . Here, we aim to demonstrate the feasibility of using this tacking system to manage an anastomotic dehiscence (AD) after oncologic laparoscopic left colectomy. AD is defined as the separation of sutures occurring within 30 days 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 the 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 . 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 2 months, he developed an AD affecting approximately a quarter of the anastomosis (approximately 15 mm), connected to a small cavity measuring 15–20 mm in diameter. The patient initially received EVT, which reduced the orifice size from 15 to 10 mm within 2 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 ( Fig. 1 and Fig. 2 a ), pulling the thread attached to the tacks, and securing the suture with a cinch device to lock the suture and cut the thread ( Fig. 2 b ). Six-week follow-up confirmed successful endoscopic closure using X-MAN (heliX tacking system for the Management of colonic ANastomotic dehiscence; Fig. 2 c ). This case demonstrates the safe and effective management of post-colectomy anastomotic dehiscence using the X-MAN ( Video 1 ).

Schematic illustration of the helix tacking system showing a sequential deployment of four helix tacks around a mucosal lesion: a Placement of four tacks around the defect in a “Z” pattern. b Transmural section of a mucosal defect showing the deployment of helix tacks around a mucosal lesion. A, adventitia; M, mucosa; Mm, muscularis mucosa; Mp, muscularis propria; SM, submucosa.

a Closure was accomplished by placing four tacks around the defect in a “Z” pattern. b Securing the suture with a cinch device to lock the suture and cut the thread. c Follow-up at 6 weeks confirmed successful endoscopic closure using the X-MAN (heliX tacking system for the Management of colonic ANastomotic dehiscence).

A helix tacking system for the management of colonic anastomotic dehiscence after a laparoscopic left colectomy.Video 1

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