Arnaud Lemmers1, Damien My Tan2, Mostafa Ibrahim3, Patrizia Loi4, Daniel De Backer5, Jean Closset6, Jacques Devière7, Olivier Le Moine8. 1. Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, ULB (Université Libre de Bruxelles), Erasme Hospital, 808 route de Lennik, 1070, Brussels, Belgium. arnaud.lemmers@erasme.ulb.ac.be. 2. Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, ULB (Université Libre de Bruxelles), Erasme Hospital, 808 route de Lennik, 1070, Brussels, Belgium. damien.tan.m.y@sgh.com.sg. 3. Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, ULB (Université Libre de Bruxelles), Erasme Hospital, 808 route de Lennik, 1070, Brussels, Belgium. mostafa.ibrahim@webgit.net. 4. Department of Abdominal Surgery, ULB (Université Libre de Bruxelles), Erasme Hospital, 1070, Brussels, Belgium. patrizia.loi@erasme.ulb.ac.be. 5. Department of Intensive Care, ULB (Université Libre de Bruxelles), Erasme Hospital, 1070, Brussels, Belgium. ddebacke@ulb.ac.be. 6. Department of Abdominal Surgery, ULB (Université Libre de Bruxelles), Erasme Hospital, 1070, Brussels, Belgium. jean.closset@erasme.ulb.ac.be. 7. Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, ULB (Université Libre de Bruxelles), Erasme Hospital, 808 route de Lennik, 1070, Brussels, Belgium. jacques.deviere@erasme.ulb.ac.be. 8. Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, ULB (Université Libre de Bruxelles), Erasme Hospital, 808 route de Lennik, 1070, Brussels, Belgium. olivier.lemoine@erasme.ulb.ac.be.
Abstract
BACKGROUND AND AIMS: Since redo surgery is associated with a high risk of morbidity and mortality after bariatric surgery in case of leakage, we sought to evaluate whether endoscopic drainage and debridement of collections following bariatric surgery is an efficient step-up approach to the management of these complications. METHODS: From 2007 to 2011, we retrospectively studied our cohort of nine cases treated by endoscopic drainage and debridement of abdominal abscesses secondary to postbariatric surgery leaks performed via the transluminal or percutaneous route. RESULTS: Three patients were treated by percutaneous endoscopic debridement of abscesses knowing that their leak was already closed by other endoscopic means and that their collection did not improve despite external drain in place. Six patients were treated by transluminal endoscopic drainage to perform necrosectomy as a first-line option or after failure of improvement after endoscopic treatment. The number of sessions required ranged from 1 to 3. Most severe patients had rapid improvement of their hemodynamic and respiratory conditions. In eight of the nine patients, we were able to close the fistula by stent, fistula plugs, or a macroclip. Resolution of collections was seen in seven out of nine patients, but two required further surgery. CONCLUSIONS: Endoscopic necrosectomy via the transluminal or percutaneous route is a feasible option in postbariatric surgery patients with necrotic abscesses not adequately managed by the classical combination of percutaneous drainage and stenting. Further wide-scale studies are needed to compare this non-surgical method with surgical necrosectomy in postbariatric surgery patients.
BACKGROUND AND AIMS: Since redo surgery is associated with a high risk of morbidity and mortality after bariatric surgery in case of leakage, we sought to evaluate whether endoscopic drainage and debridement of collections following bariatric surgery is an efficient step-up approach to the management of these complications. METHODS: From 2007 to 2011, we retrospectively studied our cohort of nine cases treated by endoscopic drainage and debridement of abdominal abscesses secondary to postbariatric surgery leaks performed via the transluminal or percutaneous route. RESULTS: Three patients were treated by percutaneous endoscopic debridement of abscesses knowing that their leak was already closed by other endoscopic means and that their collection did not improve despite external drain in place. Six patients were treated by transluminal endoscopic drainage to perform necrosectomy as a first-line option or after failure of improvement after endoscopic treatment. The number of sessions required ranged from 1 to 3. Most severe patients had rapid improvement of their hemodynamic and respiratory conditions. In eight of the nine patients, we were able to close the fistula by stent, fistula plugs, or a macroclip. Resolution of collections was seen in seven out of nine patients, but two required further surgery. CONCLUSIONS: Endoscopic necrosectomy via the transluminal or percutaneous route is a feasible option in postbariatric surgery patients with necrotic abscesses not adequately managed by the classical combination of percutaneous drainage and stenting. Further wide-scale studies are needed to compare this non-surgical method with surgical necrosectomy in postbariatric surgery patients.
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