Gianfranco Donatelli1, Ludovica Guerriero2,3, Fabrizio Cereatti4, Kostantinos Arapis5, Carmelisa Dammaro6,7, Jean-Loup Dumont2, David Fuks8, Silvana Perretta3. 1. Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France. donatelligianfranco@gmail.com. 2. Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France. 3. IRCAD/IHU-Institute of Image-Guided Surgery, 1 Place de l'Hopital, 67000, Strasbourg, France. 4. Digestive Endoscopy and Gastroenterology Unit, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy. 5. Department of General and Visceral Surgery, Bichat-Claude Bernard University Hospital, Paris, France. 6. Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, AP-, F-92140, Clamart, HP, France. 7. Paris-Saclay University, F-91405, Orsay, France. 8. Department of Digestive Surgery, Institut Mutualiste Montsouris, 75014, Paris, France.
Abstract
INTRODUCTION: Proximal gastric leak is one of the most common complications after laparoscopic sleeve gastrectomy (LSG). Endoscopy is the gold standard treatment for acute staple-line leaks. Surgery is the most effective treatment modality in case of chronic fistula. MATERIAL AND METHODS: A 55-year- old man presented an acute leak after LSG. The leak was treated with metal stent deployment with temporary closure. After 6 months, he presented leak recurrence with general sepsis, perigastric-infected collection, and gastro-jejunal fistula. RESULTS: Endoscopic internal drainage (EID) was performed; however, due to fistula persistence, a surgical procedure was proposed. The patient refused revisional surgery; therefore, endoscopic salvage procedure was decided. A fully covered metal stent was deployed in order to bypass the perigastric collection creating an endoscopic gastro-jejunal anastomosis. CONCLUSION: Revisional surgery is the gold standard treatment for chronic fistula after SG. Endoscopic treatment with SEMS deployment may be a sound option in selected cases especially after failure of other endoscopic techniques or refusal of revisional surgery.
INTRODUCTION: Proximal gastric leak is one of the most common complications after laparoscopic sleeve gastrectomy (LSG). Endoscopy is the gold standard treatment for acute staple-line leaks. Surgery is the most effective treatment modality in case of chronic fistula. MATERIAL AND METHODS: A 55-year- old man presented an acute leak after LSG. The leak was treated with metal stent deployment with temporary closure. After 6 months, he presented leak recurrence with general sepsis, perigastric-infected collection, and gastro-jejunal fistula. RESULTS: Endoscopic internal drainage (EID) was performed; however, due to fistula persistence, a surgical procedure was proposed. The patient refused revisional surgery; therefore, endoscopic salvage procedure was decided. A fully covered metal stent was deployed in order to bypass the perigastric collection creating an endoscopic gastro-jejunal anastomosis. CONCLUSION: Revisional surgery is the gold standard treatment for chronic fistula after SG. Endoscopic treatment with SEMS deployment may be a sound option in selected cases especially after failure of other endoscopic techniques or refusal of revisional surgery.
Authors: Christine Stroh; D Birk; R Flade-Kuthe; M Frenken; B Herbig; S Höhne; H Köhler; V Lange; K Ludwig; R Matkowitz; G Meyer; P Pick; Th Horbach; S Krause; L Schäfer; M Schlensak; E Shang; T Sonnenberg; M Susewind; H Voigt; R Weiner; S Wolff; A M Wolf; U Schmidt; H Lippert; Th Manger Journal: Obes Surg Date: 2009-01-29 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