BACKGROUND: Treatment of anastomotic fistulas after bariatric surgery is difficult, and they are often associated with additional surgery, sepsis, and prolonged non-oral feeding. OBJECTIVE: To assess a new, totally endoscopic strategy to manage anastomotic fistulas. DESIGN: Prospective study. SETTING: Tertiary-care university hospital. PATIENTS: This study involved 27 consecutive patients from July 2007 to December 2009. INTERVENTION: This strategy involved successive procedures for endoscopic drainage of the residual cavity, diversion of the fistula with a stent, and then closure of the residual orifice with surgical clips or sealant. MAIN OUTCOME MEASUREMENTS: Technical success, mortality and morbidity, migration of the stent. RESULTS: Multiple or complex fistulas were present in 16 cases (59%). Endoscopic drainage (nasal-fistula drain or necrosectomy) was used in 19 cases (70%). Diversion by a covered colorectal stent was used in 22 patients (81%). To close the residual or initial opening, wound clips and glue (cyanoacrylate) were used in 15 cases (55%). Neither mortality nor severe morbidity occurred. Migration of the stent occurred in 13 cases (59%) and was treated by replacement with either a longer stent or with 2 nested stents. The mean time until resolution of fistula was 86 days from the start of endoscopic management, with a mean of 4.4 endoscopies per patient. LIMITATIONS: Moderate sample size, nonrandomized study. CONCLUSION: An entirely endoscopic approach to the management of anastomosing fistulas that develop after bariatric surgery--using sequential drainage, sutures, and diversion by stents--achieved resolution of the fistulas with minimal morbidity.
BACKGROUND: Treatment of anastomotic fistulas after bariatric surgery is difficult, and they are often associated with additional surgery, sepsis, and prolonged non-oral feeding. OBJECTIVE: To assess a new, totally endoscopic strategy to manage anastomotic fistulas. DESIGN: Prospective study. SETTING: Tertiary-care university hospital. PATIENTS: This study involved 27 consecutive patients from July 2007 to December 2009. INTERVENTION: This strategy involved successive procedures for endoscopic drainage of the residual cavity, diversion of the fistula with a stent, and then closure of the residual orifice with surgical clips or sealant. MAIN OUTCOME MEASUREMENTS: Technical success, mortality and morbidity, migration of the stent. RESULTS: Multiple or complex fistulas were present in 16 cases (59%). Endoscopic drainage (nasal-fistula drain or necrosectomy) was used in 19 cases (70%). Diversion by a covered colorectal stent was used in 22 patients (81%). To close the residual or initial opening, wound clips and glue (cyanoacrylate) were used in 15 cases (55%). Neither mortality nor severe morbidity occurred. Migration of the stent occurred in 13 cases (59%) and was treated by replacement with either a longer stent or with 2 nested stents. The mean time until resolution of fistula was 86 days from the start of endoscopic management, with a mean of 4.4 endoscopies per patient. LIMITATIONS: Moderate sample size, nonrandomized study. CONCLUSION: An entirely endoscopic approach to the management of anastomosing fistulas that develop after bariatric surgery--using sequential drainage, sutures, and diversion by stents--achieved resolution of the fistulas with minimal morbidity.
Authors: Eduardo G H de Moura; Manoel P Galvão-Neto; Almino C Ramos; Eduardo T H de Moura; Thales D Galvão; Diogo T H de Moura; Flávio C Ferreira Journal: Surg Endosc Date: 2011-12-17 Impact factor: 4.584
Authors: Arnaud Lemmers; Damien My Tan; Mostafa Ibrahim; Patrizia Loi; Daniel De Backer; Jean Closset; Jacques Devière; Olivier Le Moine Journal: Obes Surg Date: 2015-11 Impact factor: 4.129
Authors: Ossamu Okazaki; Wanderley M Bernardo; Vitor O Brunaldi; Cesar C de Clemente Junior; Maurício K Minata; Diogo T H de Moura; Thiago F de Souza; Josemberg Marins Campos; Marco Aurélio Santo; Eduardo G H de Moura Journal: Obes Surg Date: 2018-06 Impact factor: 4.129
Authors: G Donatelli; J-L Dumont; F Cereatti; S Ferretti; B M Vergeau; T Tuszynski; G Pourcher; H Tranchart; P Mariani; A Meduri; J-M Catheline; I Dagher; F Fiocca; J-P Marmuse; B Meduri Journal: Obes Surg Date: 2015-07 Impact factor: 4.129