Iqbal Siddique1, Waleed Alazmi1, Salman K Al-Sabah2. 1. Department of Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait; Thunayan Al-Ghanim Gastroenterology Center, Al-Amiri Hospital, Kuwait City, Kuwait. 2. Department of Surgery, Faculty of Medicine, Kuwait University, Safat, Kuwait; Department of Surgery, Al-Amiri Hospital, Kuwait City, Kuwait. Electronic address: salman.alsabah@hsc.edu.kw.
Abstract
BACKGROUND: Leaks and fistulas after laparoscopic sleeve gastrectomy (SG) are major adverse events of bariatric surgery. Endoscopic management of post-SG leaks has evolved from closure with covered self-expanding metallic stents to endoscopic internal drainage (EID). OBJECTIVE: To report our experience with the management of post-SG leaks treated with EID, either as primary therapy or after failure of closure therapy with self-expanding metallic stents. SETTING: Single-center observational study. METHODS: A retrospective study of 20 patients treated for post-SG leaks with EID by deployment of double pigtail stents across the leak orifice, positioning one end inside the collection and the other end in the lumen of the stomach. RESULTS: There were 13 (65%) males and 7 (35%) females with a mean age of 34.2 ± 11.6 years. EID was performed after a mean 62 days after SG. Three patients had gastrobronchial fistula. Seventeen (85%) patients had failed some form of prior therapy for the leak. The mean duration of EID was 83 days and 17 (85%) patients had complete healing of the leak with a mean follow-up of 16 months. There were 2 (10%) adverse events and no mortalities. The success of EID in healing post-SG leak was significantly associated with the absence of a gastrobronchial fistula (P < .05). CONCLUSIONS: EID is an effective and safe endoscopic treatment of leaks after SG and is well tolerated. It allows early feeding and has fewer adverse events than other techniques. The presence of a gastrobronchial fistula is associated with higher failure rates. Long-term follow-up confirms a good outcome with no mortality.
BACKGROUND: Leaks and fistulas after laparoscopic sleeve gastrectomy (SG) are major adverse events of bariatric surgery. Endoscopic management of post-SG leaks has evolved from closure with covered self-expanding metallic stents to endoscopic internal drainage (EID). OBJECTIVE: To report our experience with the management of post-SG leaks treated with EID, either as primary therapy or after failure of closure therapy with self-expanding metallic stents. SETTING: Single-center observational study. METHODS: A retrospective study of 20 patients treated for post-SG leaks with EID by deployment of double pigtail stents across the leak orifice, positioning one end inside the collection and the other end in the lumen of the stomach. RESULTS: There were 13 (65%) males and 7 (35%) females with a mean age of 34.2 ± 11.6 years. EID was performed after a mean 62 days after SG. Three patients had gastrobronchial fistula. Seventeen (85%) patients had failed some form of prior therapy for the leak. The mean duration of EID was 83 days and 17 (85%) patients had complete healing of the leak with a mean follow-up of 16 months. There were 2 (10%) adverse events and no mortalities. The success of EID in healing post-SG leak was significantly associated with the absence of a gastrobronchial fistula (P < .05). CONCLUSIONS:EID is an effective and safe endoscopic treatment of leaks after SG and is well tolerated. It allows early feeding and has fewer adverse events than other techniques. The presence of a gastrobronchial fistula is associated with higher failure rates. Long-term follow-up confirms a good outcome with no mortality.