811 Management of Endoscopic Perforation With Abdominal Exploration and Full-Thickness Sutured Closure

Abstract

created to achieve durable response. Multiple sessions are required in certain patients. All procedures were done under general anesthesia. Results: Six patients (4F, 2M) presented for closure of chronic enteric fistulas.This included: 1. esophagomediastinal (n=1), 2. gastrocutaneous (n=3), 3. bronchial-esophageal (n=2). The patient with esophagomediastinal fistula (5 cm size) was repaired with an enteral stent deployment and fixation of the proximal end of the stent to the esophagus. The three patients with gastrocutaneous fistulas (n=3) all were as a result of bariatric surgery, all closed successfully with combination of interrupted and running sutures in two separate layers. One of these patients developed a dehiscence at 10 days postprocedure and was closed after a second suturing session. Finally the two patients with bronchial-esophageal fistulas (n=2) were closed successfully but dehiscence of the sutures required repeat suturing sessions (3 and 4 sessions respectively) prior to final closure. No complications were observed. Patients resumed oral diets within 7-14 days following closure. Contrast studies were done in all patients to ensure complete closure within 48 hours of the procedure. Conclusions: Enteric fistulas may present a therapeutic challenge. Surgical options may have significant morbidity and mortality. Endoscopic suturing can successfully close enteric fistulas with low