Endoscopic suture-based closure of a dehiscent rectal stump

Lower anterior rectal resection (LAR) with discontinuity resection is performed to avoid leakage of the colorectal anastomosis in high risk patients [1]. Unfortunately, rectal stump leakage can occur, and reoperation is associated with high morbidity and mortality. Endoscopic techniques, such as rinsing or vacuum-based therapy, have shown promising results in rectal leak management [2]. Recently, various endoscopic suture-based techniques have been introduced to facilitate gastrointestinal defect closure and leak or fistula management [3]. We describe the case of a 66-year-old man with rectal stump leakage, presenting to our unit 12 days after LAR and discontinuity resection. We opted for a two-step approach with initial suturing of the large post-surgical defect using the through-the-scope X-Tack Endoscopic HeliX Tacking System (Apollo Endosurgery, Austin, Texas, USA) ([Video 1]).