Endoscopic purse-string suture technique for postoperative drain-related leakage management in gastrointestinal surgery.

Abstract

Background: Abdominal drain-associated fistulas (ADAFs) represent severe complications following gastrointestinal surgery, where conventional surgical reintervention carries invasiveness risks and extended recovery periods. This study evaluates the clinical efficacy and safety of endoscopic purse-string suturing for managing ADAFs.

Methods: A retrospective cohort analysis included 41 patients with postoperative ADAFs treated at Shandong Second Medical University and external referral centers between January 2015 and June 2024.

Results: Endoscopic intervention achieved technical success in 87.8% (36/41) of cases, with clinical success observed in 63.4% (26/41). Subgroup analysis demonstrated significantly superior clinical outcomes in isolated ADAFs versus cases involving concurrent anastomotic disruption (90.0% vs. 39.1%, P = 0.001). Multivariate regression identified two independent predictors of reduced therapeutic efficacy: preoperative anastomotic stenosis (OR = 0.083, P = 0.041) and fistulous orifice diameter > 1 cm (OR = 0.039, P = 0.004). During 12-month follow-up, no mortality or fistula recurrence occurred. Postprocedural anastomotic stenosis developed in 4.9% (2/41) of patients, successfully managed through endoscopic balloon dilation (n = 1) and gastrointestinal stent placement (n = 1).

Conclusion: Endoscopic purse-string suturing emerges as a minimally invasive, safe, and effective therapeutic strategy for ADAFs, particularly demonstrating optimal clinical performance in isolated drain-associated fistulas with orifices ≤ 1 cm diameter.