Tomasz Klimczak1,2, Jerzy Klimczak3, Tomasz Szewczyk3, Przemysław Janczak3, Piotr Jurałowicz3. 1. Department of General and Oncological Surgery, Central Clinical Hospital in Łódź, Łódź Medical University, Pomorska St. 251, Łódź, Poland. tjjklimczak@gmail.com. 2. , Łęczycka St. 60/62/10, Łódź, Poland. tjjklimczak@gmail.com. 3. Department of Gastroenterological, Oncological and General Surgery, 1st Clinical Hospital in Łódź, Łódź Medical University, Kopcińskiego St. 22, Łódź, Poland.
Abstract
BACKGROUND: Sleeve gastrectomy has become one of the main bariatric procedures over the last few years. This can be explained by the relative simplicity and high effectiveness of this method. Yet, it causes complications as any other method. Staple line leaks are the most frequent ones. According to different sources, this complication may occur with 0-7% frequency. Until 2013, surgery was the only effective treatment method for this complication. However, reoperations considerably increased treatment cost and patient morbidity. The aim of this study is to present the possibilities of endoscopic treatment of leaks after laparoscopic sleeve gastrectomy. METHODS: From 2014 to 2016 14, cases of leaks following sleeve gastrectomy were diagnosed in our Department in Łódź. All of them were treated with MEGA stent in order to cover the leak site. Due to severe peritonitis, 3 patients had to undergo surgery prior to implantation of the prosthesis. Another patient underwent an unsuccessful attempt of leak closing via OTSC method prior to implantation of the prosthesis. Patients were nourished from the 3rd day after the surgery. On average, prostheses were removed on the 34th day after the implantation. RESULTS: The leak was fully sealed in 13 out of 14 cases. In 10 cases the leak was fully healed. There were 2 cases of patients' deaths: the result of a multi-organ failure in one case and early esophageal perforation in the other one. The overall success rate was 90.9%. CONCLUSION: Sealing leaks occurring after sleeve gastrectomy with MEGA stents represent an effective method and should become the technique of choice.
BACKGROUND: Sleeve gastrectomy has become one of the main bariatric procedures over the last few years. This can be explained by the relative simplicity and high effectiveness of this method. Yet, it causes complications as any other method. Staple line leaks are the most frequent ones. According to different sources, this complication may occur with 0-7% frequency. Until 2013, surgery was the only effective treatment method for this complication. However, reoperations considerably increased treatment cost and patient morbidity. The aim of this study is to present the possibilities of endoscopic treatment of leaks after laparoscopic sleeve gastrectomy. METHODS: From 2014 to 2016 14, cases of leaks following sleeve gastrectomy were diagnosed in our Department in Łódź. All of them were treated with MEGA stent in order to cover the leak site. Due to severe peritonitis, 3 patients had to undergo surgery prior to implantation of the prosthesis. Another patient underwent an unsuccessful attempt of leak closing via OTSC method prior to implantation of the prosthesis. Patients were nourished from the 3rd day after the surgery. On average, prostheses were removed on the 34th day after the implantation. RESULTS: The leak was fully sealed in 13 out of 14 cases. In 10 cases the leak was fully healed. There were 2 cases of patients' deaths: the result of a multi-organ failure in one case and early esophageal perforation in the other one. The overall success rate was 90.9%. CONCLUSION: Sealing leaks occurring after sleeve gastrectomy with MEGA stents represent an effective method and should become the technique of choice.
Entities:
Keywords:
Endoscopic management of bariatric complications; Endoscopic surgery; Leaks after LSG; MEGA esophageal stent; Minimally invasive treatment
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