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Endoscopy is the gold standard for the treatment of postoperative gastric leaks (GL). Large fistulas are associated with high rate of treatment failure. The objective of this study was to assess the clinical efficacy of a combining technique using a covered stent (CS) crossing through pigtails (PDs) for large postsurgical GL leaks.All consecutive patients with large ( 10 mm) postsurgical GL treated endoscopically with a combination of a CS and PDs were included in a single-center retrospective study. The primary endpoint was the rate of GL closure.A total of 29 patients were included. Twenty-five patients underwent sleeve gastrectomy. The fistula (median diameter 15 mm) was diagnosed 6 days (IQR 4-9) after surgery. Technical success was observed in all procedures. After a median follow-up of 10.7 months (IQR 3.8-20.7), GL closure was observed in 82.7% with a median time of 63 days (IQR 40-90). Surgical management was finally necessary in four patients after a median of 186 days (IQR 122-250). No complications related to combined endoscopic treatment were observed especially stent migration during the follow-up.An endoscopic strategy combining CS crossing through PDs appears to be effective, safe and well tolerated for the treatment of large GL.

This report describes a technique for the treatment of patients with chronic pelvic anastomotic sinuses (AS) after low anastomosis for rectal cancer in which transanal stapled marsupialisation is performed.We reviewed the clinical history of a 62-year-old patient who had a symptomatic chronic pelvic AS more than 6 months after stapled low colorectal side-to-end anastomosis with loop ileostomy for a stage II cancer of the mid rectum without preoperative radiochemotherapy. Pelvic abscess was recurrent three times after percutaneous drainage, operative transanal drainage, and treatment with fibrin glue and ileostomy closure. The fourth treatment was a marsupialisation of the AS. The marsupialisation consisted of a section of the common wall between the colon lumen and the AS. It was performed by transanal route under general anaesthesia with a laparoscopic stapler.There was no intraoperative complication. The postoperative course was uneventful, and the patient was discharged without symptoms. At 3 months, the clinical examination was normal. Functional results were good without defecation disorders.Marsupialisation with a stapler of a chronic AS after low anastomosis for rectal cancer is an effective and efficient technique. On the basis of our experience, we believe that it may be an alternative management of the chronic AS. It allows conservation of the anastomosis.