Review: Therapeutic endoscopy for the treatment of anastomotic dehiscences

Alberto Arezzo, Mauro Verra, Giuseppe Galloro, Mario De Bellis, Antonello Trecca, Raffaele Manta, Mario Morino

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Anastomotic dehiscence is a major complication of surgery of the digestive tract with high morbidity and mortality rate. Its management differs, depending mainly on clinical presentation. Technological improvement allowed development of endoscopic devices that can be adopted as an alternative to surgical management in selected cases of anastomotic leakage. The presence of generalized peritonitis, high-grade sepsis, and hemodynamic instability requires resuscitation and surgical management. Otherwise, endoscopy may be considered. Three main kind of endoscopic devices can be used for this purpose: synthesis and suturing devices, EndoVac therapy, and covered stents. Synthesis and suturing devices allow a direct closure of gastrointestinal defect. They include different clipping devices (OTSC system having demonstrated the higher success rate) and suturing devices. They are indicated in small leakage up to 20 mm of diameter. EndoVac system is based on the application of topic negative pressure on tissues in order to drain and favor granulation and secondary closure of large defects. It is indicated in large anastomotic leaks when an extra-luminal cavity is present (more often extraperitoneal or mediastinal dehiscences). Temporal application and periodical substitutions of covered stents adopt the principle of excluding the wall defect from contamination of gastrointestinal lumen. This system requires drained or clean extra-luminal tissues in order not to create bacterial proliferation and abscess formation. Many other endoscopic devices (such as fibrin glue injection) may be used in combination in the endoscopic management of an anastomotic dehiscence. It is hoped that future technological improvements will extend options of endoscopic management of surgical complications.

Original languageEnglish
Title of host publicationEndoscopic follow-up of digestive anastomosis
PublisherSpringer-Verlag Italia s.r.l.
Pages119-130
Number of pages12
ISBN (Print)9788847053700, 8847053692, 9788847053694
DOIs
Publication statusPublished - Apr 1 2014

ASJC Scopus subject areas

  • Medicine(all)

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    Arezzo, A., Verra, M., Galloro, G., De Bellis, M., Trecca, A., Manta, R., & Morino, M. (2014). Review: Therapeutic endoscopy for the treatment of anastomotic dehiscences. In Endoscopic follow-up of digestive anastomosis (pp. 119-130). Springer-Verlag Italia s.r.l.. https://doi.org/10.1007/978-88-470-5370-0-14