Endoscopic Stapled Marsupialisation of Chronic Presacral Sinus following Low Anterior Resection: A Simple Option in Selected Cases

Abstract

BACKGROUND AND AIMS: Chronic presacral sinus (CPS) following anastomose leakage is one of the most serious complications after restorative colorectal surgery. CPS is associated with long course of treatments and can prevent stoma closure. We present our experience with endoscopic stapled marsupialisation (ESM) of CPS. MATERIALS AND METHODS: Seven patients underwent ESM. All patients had developed a CPS after clinical anastomotic leakage following low anterior resection with diverting ileostomy. Initially the patients were treated conservatively and with endoscopic vacuum-assisted closure (Endo-VAC). RESULTS AND CONCLUSION: ESM procedure was successful for six patients, resulted in good healing in four patients and no sinus recurrence of the CPS. In two patients the stoma was re-versed. Two patients were treated with neo-adjuvant chemoradiotherapy, who also developed small bowel fistulae. ESM is a simple treatment for CPS and can accelerate healing of chronic presacral cavity, reduce complications and enable to reverse the stoma in selected cases.