Forcignanò Edoardo, Verra Mauro, Lo Secco Giacomo, Arezzo Alberto
Department of Surgical Sciences, University of Turin, Turin, Italy.
Visc Med. 2025 Jun 27. doi: 10.1159/000547021.
Anastomotic leaks and fistulas are a feared and challenging postoperative complication in colorectal surgery. Traditionally managed with protective ileostomy and revisional surgery, less-invasive endoscopic approaches are increasingly being utilized.
This article provides a comprehensive overview of current endoscopic treatment principles for managing anastomotic leaks after colorectal surgery. These approaches can be categorized into three main strategies: - using negative pressure via polyurethane foam drains to promote wound healing and drain secretions; - including endoscopic suturing systems (e.g., OverStitch) and clipping devices (e.g., over-the-scope clip) to approximate tissue and close defects; and - a hybrid approach that combines negative pressure therapy with defect coverage using a covered self-expanding metal mesh stent (VAC-stent). Each method offers unique advantages depending on the leak characteristics and timing of detection. Early diagnosis and individualized treatment selection are critical to successful outcomes.
Endoscopic treatment of anastomotic insufficiencies represents a minimally invasive, effective and safe alternative to traditional surgical interventions, particularly in clinically stable patients.
吻合口漏和瘘是结直肠手术中令人担忧且具有挑战性的术后并发症。传统上采用保护性回肠造口术和修复手术进行处理，如今越来越多地采用侵入性较小的内镜方法。
本文全面概述了结直肠手术后吻合口漏的当前内镜治疗原则。这些方法可分为三种主要策略：——通过聚氨酯泡沫引流管利用负压促进伤口愈合并引流分泌物；——包括内镜缝合系统（如OverStitch）和夹闭装置（如内镜套扎夹）来使组织靠拢并闭合缺损；——一种混合方法，即使用带覆膜的自膨式金属网支架（VAC支架）将负压治疗与缺损覆盖相结合。每种方法根据漏的特征和检测时机都有独特优势。早期诊断和个体化治疗选择对成功治疗结果至关重要。
内镜治疗吻合口功能不全是传统手术干预的一种微创、有效且安全的替代方法，尤其适用于临床状况稳定的患者。
