Fabio Garofalo1, Maxime Noreau-Nguyen1, Ronald Denis1, Henri Atlas1, Pierre Garneau1, Radu Pescarus2. 1. Département de Chirurgie, Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada. 2. Département de Chirurgie, Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada. Electronic address: radupes@yahoo.com.
Abstract
BACKGROUND: Laparoscopic sleeve gastrectomy (SG) has become a widely accepted option in the treatment of morbid obesity. Gastric leaks after SG occur in .9%-2.2% of the patients, mostly at the gastroesophageal junction. The current treatment algorithm includes drainage, antibiotics, nutritional support, and endoluminal control. OBJECTIVES: Our hypothesis is that long, fully covered stents represent a safe, effective solution for SG leaks. SETTING: University hospital. METHODS: A retrospective analysis of our prospectively collected bariatric database was performed between June 2014 and May 2016. We included all patients treated for leaks after SG. Endoscopic treatment included partially covered metallic stent (Wallstent, Boston Scientific, Galway, Ireland), fully covered stent (Mega stent, Taewoong Medical Industries, Gyeonggi-do, South Korea), over-the-scope clip (Ovesco Endoscopy, Tubingen, Germany), and internal pigtail drainage. RESULTS: A total of 872 SGs were performed. Overall, 10 of 872 patients (1.1%) developed a gastric leak. One patient was an outside referral. The 11 patients underwent endoscopic treatment accompanied by either percutaneous or laparoscopic abscess drainage. Endoscopic fistula closure at the gastroesophageal junction was achieved in 10 of 11 cases and the average time for closure was 9.9 (range: 4-24) weeks. One patient developed a second leak in the antrum, treated by subtotal gastrectomy. Overall, treatment with Wallstent failed in 3 of 5 patients, and these patients were eventually successfully treated with a Mega stent. The initial use of long, fully covered stents was successful in 5 of 6 cases. CONCLUSION: Long, fully covered stents appear to be a good alternative to traditional stents either as primary treatment or after failure of other endoscopic treatments.
BACKGROUND: Laparoscopic sleeve gastrectomy (SG) has become a widely accepted option in the treatment of morbid obesity. Gastric leaks after SG occur in .9%-2.2% of the patients, mostly at the gastroesophageal junction. The current treatment algorithm includes drainage, antibiotics, nutritional support, and endoluminal control. OBJECTIVES: Our hypothesis is that long, fully covered stents represent a safe, effective solution for SG leaks. SETTING: University hospital. METHODS: A retrospective analysis of our prospectively collected bariatric database was performed between June 2014 and May 2016. We included all patients treated for leaks after SG. Endoscopic treatment included partially covered metallic stent (Wallstent, Boston Scientific, Galway, Ireland), fully covered stent (Mega stent, Taewoong Medical Industries, Gyeonggi-do, South Korea), over-the-scope clip (Ovesco Endoscopy, Tubingen, Germany), and internal pigtail drainage. RESULTS: A total of 872 SGs were performed. Overall, 10 of 872 patients (1.1%) developed a gastric leak. One patient was an outside referral. The 11 patients underwent endoscopic treatment accompanied by either percutaneous or laparoscopic abscess drainage. Endoscopic fistula closure at the gastroesophageal junction was achieved in 10 of 11 cases and the average time for closure was 9.9 (range: 4-24) weeks. One patient developed a second leak in the antrum, treated by subtotal gastrectomy. Overall, treatment with Wallstent failed in 3 of 5 patients, and these patients were eventually successfully treated with a Mega stent. The initial use of long, fully covered stents was successful in 5 of 6 cases. CONCLUSION: Long, fully covered stents appear to be a good alternative to traditional stents either as primary treatment or after failure of other endoscopic treatments.
Authors: Michele Marchese; Lucia Romano; Antonio Giuliani; Giovanni Cianca; Alessandra Di Sibio; Francesco Carlei; Gianfranco Amicucci; Mario Schietroma Journal: Int J Surg Case Rep Date: 2018-11-13
Authors: Franck Billmann; Aylin Pfeiffer; Peter Sauer; Adrian Billeter; Christian Rupp; Ronald Koschny; Felix Nickel; Moritz von Frankenberg; Beat Peter Müller-Stich; Anja Schaible Journal: Obes Surg Date: 2021-11-03 Impact factor: 4.129
Authors: Hytham K S Hamid; Sameh H Emile; Alan A Saber; Mürşit Dincer; Diogo T H de Moura; Lennard P L Gilissen; Majid A Almadi; Mauro Montuori; Michel Vix; Luis G S Perisse; Nicolás Quezada; Fabio Garofalo; Radu Pescarus Journal: Surg Endosc Date: 2020-11-06 Impact factor: 4.584