Majid Abdularahman Almadi1,2, Fahad Bamihriz3, Othman Alharbi4, Nahla Azzam4, Ahmed Aljammaz5, Mohanned Eltayeb4, Salem Thaniah4, Abdullah Aldohayan3, Abdulrahman Aljebreen4. 1. Division of Gastroenterology, King Khalid University Hospital, King Saud University, P.O. Box 2925(59), Riyadh, 11461, Saudi Arabia. maalmadi@ksu.edu.sa. 2. Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, Canada. maalmadi@ksu.edu.sa. 3. Division of Surgery, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. 4. Division of Gastroenterology, King Khalid University Hospital, King Saud University, P.O. Box 2925(59), Riyadh, 11461, Saudi Arabia. 5. Division of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
Abstract
BACKGROUND: Use of a self-expandable metal stent (SEMS) as an initial intervention for leaks after laparoscopic sleeve gastrectomy (LSG) has increased. We assessed the efficacy and safety of SEMS in the treatment of post-LSG leaks, and the determinants of repeated rounds of stenting. METHODS: A retrospective chart review was conducted at a university hospital in Saudi Arabia. The study included patients who developed leaks after undergoing LSG between October 2011 and April 2016. RESULTS: Sixty-four patients (mean age, 35.69 ± 10.71 years) were included; 55% were males. The mean estimated size of the defect was 1.18 cm; partially covered SEMS and fully covered SEMS were used as the initial stents in 82.81 and 17.19% patients, respectively. One round of stenting was required in most patients (82.81%), two rounds in 10.94%, and three rounds in 6.25%. Clinical success was achieved in 93.75% patients, including 78.13% in the first round, 89.06% by the second round, and 93.75% by the third round. A higher proportion of patients who needed one round of stenting received a partially covered SEMS compared to those who needed two rounds (91.11 vs. 42.86%, p < 0.01). Additionally, the rate of migration in patients who underwent two rounds was higher than that in patients who underwent one round (42.86 vs. 5.26%, p < 0.01) of stenting. CONCLUSION: Repeated stenting for leaks after LSG is an effective and safe intervention. The efficacy of partially covered SEMS appears superior to that of the fully covered SEMS.
BACKGROUND: Use of a self-expandable metal stent (SEMS) as an initial intervention for leaks after laparoscopic sleeve gastrectomy (LSG) has increased. We assessed the efficacy and safety of SEMS in the treatment of post-LSG leaks, and the determinants of repeated rounds of stenting. METHODS: A retrospective chart review was conducted at a university hospital in Saudi Arabia. The study included patients who developed leaks after undergoing LSG between October 2011 and April 2016. RESULTS: Sixty-four patients (mean age, 35.69 ± 10.71 years) were included; 55% were males. The mean estimated size of the defect was 1.18 cm; partially covered SEMS and fully covered SEMS were used as the initial stents in 82.81 and 17.19% patients, respectively. One round of stenting was required in most patients (82.81%), two rounds in 10.94%, and three rounds in 6.25%. Clinical success was achieved in 93.75% patients, including 78.13% in the first round, 89.06% by the second round, and 93.75% by the third round. A higher proportion of patients who needed one round of stenting received a partially covered SEMS compared to those who needed two rounds (91.11 vs. 42.86%, p < 0.01). Additionally, the rate of migration in patients who underwent two rounds was higher than that in patients who underwent one round (42.86 vs. 5.26%, p < 0.01) of stenting. CONCLUSION: Repeated stenting for leaks after LSG is an effective and safe intervention. The efficacy of partially covered SEMS appears superior to that of the fully covered SEMS.
Entities:
Keywords:
Bariatric surgery; Endoscopy; Fistula; Laparoscopic sleeve gastrectomy; Self-expandable metal stents; Staple line leaks
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