suturing in managing abdominal drain-associated fistulas following
gastrointestinal surgery. These fistulas represent serious postoperative complications where conventional surgical reintervention can be highly invasive and associated with prolonged recovery times.
The retrospective cohort analysis included 41 patients with ADAFs treated between January 2015 and June 2024 at Shandong Second Medical University and affiliated referral centers. The primary goal was to assess the technical feasibility, clinical success, and safety profile of endoscopic purse-string suturing as a therapeutic option for these challenging postoperative complications.
The investigators concluded that endoscopic purse-string suturing is a safe and effective minimally invasive strategy for managing ADAFs, with optimal results observed in isolated drain-related fistulas with small orifices.
However, the study had certain limitations. Its retrospective design introduces potential selection and information biases, while the relatively small sample size may limit the statistical power to detect all clinically relevant differences. Moreover, there were no direct comparisons with alternative management strategies, such as traditional surgical repair or conservative treatment.
The authors emphasize that larger, prospective, multicenter studies are needed to better define clinical indications, evaluate long-term safety, and establish standardized postoperative follow-up protocols.
"The endoscopic purse-string suture technique offers a promising, minimally invasive option for managing drain-related fistulas after gastrointestinal surgery. It's significant clinical efficacy, particularly for small, isolated fistulas, along with a favorable safety profile, supports its consideration as a preferred therapeutic approach in suitable patients," the authors wrote.
Zhu, G., Kong, L., Liu, X. et al. Endoscopic purse-string suture technique for postoperative drain-related leakage management in gastrointestinal surgery. BMC Surg 25, 439 (2025). https://doi.org/10.1186/s12893-025-03171-6
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