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DOI: 10.1055/a-2194-0305
Endoscopic closure of a refractory urethroanal fistula using an innovative wound closure device
Gastrointestinal (GI) fistula is a rare chronic disease that affects the quality of life of patients and represents a real therapeutic challenge, with frequent recurrences [1]. Endoscopic management of GI fistulas combines both endoscopic submucosal dissection (ESD) and mechanical closure of the orifice [2]. We recently reported that the strategy of fistula endoscopic submucosal dissection with clip closure (FESDC) is effective and safe for permanent closure of GI fistulas [3], including in the exceptional cases where an aortoesophageal fistula has occurred [4]. In the case of anal fistulas, mechanical closure remains the greatest challenge because of the proximity of the anal sphincter, which does not allow effective closure using standard or over-the-scope clips.
We herein report the case of a 29-year-old man referred for a refractory urethroanal fistula with an existing intermediate imperforate anus requiring multiple surgical and endoscopic procedures.
We first performed the endoscopic examination without anesthetic. The fistula was visualized on the posterior wall of the anal verge during micturition by the patient, the bladder having first been filled with blue dye using a urinary catheter ([Fig. 1]). After ESD of the internal orifice of the fistula, we decided to use the new Sutuart flexible needle holder (Olympus, Tokyo, Japan) [5] with a barbed suture (Medtronic, USA) to suture together the edges of the dissected fistula tract ([Fig. 2], [Video 1]). This novel device allowed us to suture under endoscopic control in a tight area using barbed suture ([Fig. 3]). Technical success was achieved, defined by tight sealing of the orifice confirmed by opacification at the end of the procedure without any urine leakage ([Fig. 4]). No adverse event was reported. Suturing techniques with this new needle holder could be added to the range of existing closure methods after ESD of gastrointestinal fistulas.
Video 1 Endoscopic closure of a refractory urethroanal fistula using an innovative wound closure device.
Quality:
Endoscopy_UCTN_Code_TTT_1AQ_2AG
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Endoscopy 2023; 55: E1105–E1107. doi: 10.1055/a-2177-3695.
Publication History
Article published online:
21 December 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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References
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