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Minerva Surgery 2021 Aug 02

DOI: 10.23736/S2724-5691.21.08781-5


lingua: Inglese

Multimodal treatment of colorectal postsurgical leaks: long-term results of the over-thescope clip (OTSC) application

Damiano CHIARI 1 , Carlotta LA RAJA 2, 3, Benedetto MANGIAVILLANO 1, Paolo VERONESI 1, Marco PLATTO 1, Walter ZULIANI 1

1 Department of General Surgery, Istituto Clinico Humanitas Mater Domini, Castellanza, Varese, Italy; 2 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; 3 Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy


BACKGROUND: Post-surgical anastomotic colorectal leaks often require a surgical second look with a definite morbidity and the risk of delaying adjuvant treatment. The aim of this study is to analyse the long-term results of the endoscopic closure of colorectal leak following low anterior resection (LAR) using the over-the-scope (Ovesco™) clip.
METHODS: Patients who were submitted to endoscopic closure of a colorectal leak of maximum 2 cm with an Ovesco™ clip following LAR from 2016 to 2018 were enrolled in this retrospective single-center study (Humanitas Mater Domini Clinical Institute, Italy). The follow-up was obtained through radiologic and clinic assessments.
RESULTS: In the study period 48 patients were submitted to LAR. Six patients were enrolled in the study. The median diameter of the leak was 7 mm. 14/6t or 12/6t OTSC® clip was applied. Three patients were managed exclusively endoscopically, 2 of them had a protective ileostomy; 3 patients underwent urgent laparotomy with ostomy and then underwent endoscopic procedure. Complete healing was reached in all patients in a median of 23 days. Adjuvant chemotherapy was indicated and performed in 4 patients after a median of 64 days from the surgery. Among the 5 carriers of an ostomy, 4 patients underwent recanalization. The median follow-up was 21.5 months. During the follow-up no leak reoccurrence or complications were reported.
CONCLUSIONS: In the multimodal management of anastomotic leaks following LAR , Ovesco™ clipping system appears a safe and effective technique in the closure of small leaks (<2 cm), allowing an early recanalization of the bowel and not delaying adjuvant chemotherapy when indicated.

KEY WORDS: Anastomotic leak; Endoscopy; Colorectal surgery

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