1
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Medas R, Rodrigues-Pinto E. Endoscopic treatment of upper gastrointestinal postsurgical leaks: a narrative review. Clin Endosc 2023; 56:693-705. [PMID: 37430398 PMCID: PMC10665610 DOI: 10.5946/ce.2023.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/28/2023] [Accepted: 04/01/2023] [Indexed: 07/12/2023] Open
Abstract
Upper gastrointestinal postsurgical leaks are life-threatening conditions with high mortality rates and are one of the most feared complications of surgery. Leaks are challenging to manage and often require radiological, endoscopic, or surgical intervention. Steady advancements in interventional endoscopy in recent decades have allowed the development of new endoscopic devices and techniques that provide a more effective and minimally invasive therapeutic option compared to surgery. Since there is no consensus regarding the most appropriate therapeutic approach for managing postsurgical leaks, this review aimed to summarize the best available current data. Our discussion specifically focuses on leak diagnosis, treatment aims, comparative endoscopic technique outcomes, and combined multimodality approach efficacy.
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Affiliation(s)
- Renato Medas
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Eduardo Rodrigues-Pinto
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
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2
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Medas R, Rodrigues-Pinto E. Technical Review on Endoscopic Treatment Devices for Management of Upper Gastrointestinal Postsurgical Leaks. Gastroenterol Res Pract 2023; 2023:9712555. [PMID: 37342388 PMCID: PMC10279499 DOI: 10.1155/2023/9712555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/20/2022] [Accepted: 11/25/2022] [Indexed: 06/22/2023] Open
Abstract
Upper gastrointestinal postsurgical leaks are challenging to manage and often require radiological, endoscopic, or surgical intervention. Nowadays, endoscopy is considered the first-line approach for their management, however, there is no definite consensus on the most appropriate therapeutic approach. There is a wide diversity of endoscopic options, from close-cover-divert approaches to active or passive internal drainage approaches. Theoretically, all these options can be used alone or with a multimodality approach, as each of them has different mechanisms of action. The approach to postsurgical leaks should always be tailored to each patient, taking into account the several variables that may influence the final outcome. In this review, we discuss the important developments in endoscopic devices for the treatment of postsurgical leaks. Our discussion specifically focuses on principles and mechanism of action, advantages and disadvantages of each technique, indications, clinical success, and adverse events. An algorithm for endoscopic approach is proposed.
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Affiliation(s)
- Renato Medas
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Eduardo Rodrigues-Pinto
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
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3
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Ahn JY. Endoscopic management of postoperative upper gastrointestinal leakage. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2022. [DOI: 10.18528/ijgii220046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ji Yong Ahn
- Departments of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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4
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Bin Dahmash A, Arabi M, Alfutais A, Alswayah MA, Alshehri S, Salman R, Zahrani YA, Almoaiqel M. Gastroesophageal Stents for the Management of Post Sleeve Gastrectomy Leakage: Interventional Radiology Experience. THE ARAB JOURNAL OF INTERVENTIONAL RADIOLOGY 2022. [DOI: 10.1055/s-0041-1742086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Objective The aim of this study was to assess the efficacy and safety of retrievable, self-expandable gastroesophageal stents to manage gastric leaks post sleeve gastrectomy by interventional radiology (IR).
Methods This is a retrospective study of patients with gastric leaks post sleeve gastrectomy who were managed with gastroesophageal stent placement. The diameters of the stents ranged from 23 to 30 mm and the lengths 12.5 to 24 cm.
Results Thirty-one patients (mean age, 32.4 ± 7.97 years) were included in the study, and 46 stents were placed. The total average stenting time was 59.1 ± 35.5 days. Leakage resolved in 93.5% of the patients. Thirty-eight (82.6%) of the stents were retrieved by IR, and the remaining stents were retrieved under endoscopic visualization. Stricture occurred as a complication in four patients: three of which were treated with stenting (one by IR and two by endoscopy) and one required esophagoplasty. Six patients experienced stent migration, three of which underwent stent adjustment, while the remaining three underwent stent reinsertion
Conclusion Gastroesophageal stent placement by IR for gastric leaks post sleeve gastrectomy is safe and effective in our study.
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Affiliation(s)
- Abdulmajeed Bin Dahmash
- Vascular and Interventional Radiology Unit, Department of Medical Imaging, King Abdulaziz Medical City & King Abdullah Specialized Children's Hospital, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Mohammad Arabi
- Vascular and Interventional Radiology Unit, Department of Medical Imaging, King Abdulaziz Medical City & King Abdullah Specialized Children's Hospital, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Aljabriyah Alfutais
- Vascular and Interventional Radiology Unit, Department of Medical Imaging, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Mohammed A. Alswayah
- Vascular and Interventional Radiology Unit, Department of Medical Imaging, King Abdulaziz Medical City & King Abdullah Specialized Children's Hospital, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Shaker Alshehri
- Vascular and Interventional Radiology Unit, Department of Medical Imaging, King Abdulaziz Medical City & King Abdullah Specialized Children's Hospital, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Refaat Salman
- Vascular and Interventional Radiology Unit, Department of Medical Imaging, King Abdulaziz Medical City & King Abdullah Specialized Children's Hospital, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Yousof Al Zahrani
- Vascular and Interventional Radiology Unit, Department of Medical Imaging, King Abdulaziz Medical City & King Abdullah Specialized Children's Hospital, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed Almoaiqel
- Vascular and Interventional Radiology Unit, Department of Medical Imaging, King Abdulaziz Medical City & King Abdullah Specialized Children's Hospital, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
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5
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Kalidasan V, Yang X, Xiong Z, Li RR, Yao H, Godaba H, Obuobi S, Singh P, Guan X, Tian X, Kurt SA, Li Z, Mukherjee D, Rajarethinam R, Chong CS, Wang JW, Ee PLR, Loke W, Tee BCK, Ouyang J, Charles CJ, Ho JS. Wirelessly operated bioelectronic sutures for the monitoring of deep surgical wounds. Nat Biomed Eng 2021; 5:1217-1227. [PMID: 34654900 DOI: 10.1038/s41551-021-00802-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 09/02/2021] [Indexed: 02/07/2023]
Abstract
Monitoring surgical wounds post-operatively is necessary to prevent infection, dehiscence and other complications. However, the monitoring of deep surgical sites is typically limited to indirect observations or to costly radiological investigations that often fail to detect complications before they become severe. Bioelectronic sensors could provide accurate and continuous monitoring from within the body, but the form factors of existing devices are not amenable to integration with sensitive wound tissues and to wireless data transmission. Here we show that multifilament surgical sutures functionalized with a conductive polymer and incorporating pledgets with capacitive sensors operated via radiofrequency identification can be used to monitor physicochemical states of deep surgical sites. We show in live pigs that the sutures can monitor wound integrity, gastric leakage and tissue micromotions, and in rodents that the healing outcomes are equivalent to those of medical-grade sutures. Battery-free wirelessly operated bioelectronic sutures may facilitate post-surgical monitoring in a wide range of interventions.
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Affiliation(s)
- Viveka Kalidasan
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore.
| | - Xin Yang
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore
| | - Ze Xiong
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore. .,Institute for Health Innovation and Technology, National University of Singapore, Singapore, Singapore. .,The N.1 Institute for Health, National University of Singapore, Singapore, Singapore.
| | - Renee R Li
- Cardiovascular Research Institute, National University Heart Centre, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Haicheng Yao
- Department of Materials Science and Engineering, National University of Singapore, Singapore, Singapore
| | - Hareesh Godaba
- Department of Materials Science and Engineering, National University of Singapore, Singapore, Singapore
| | - Sybil Obuobi
- Department of Pharmacy, National University of Singapore, Singapore, Singapore.,Drug Transport and Delivery Research Group, Department of Pharmacy, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Priti Singh
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Xin Guan
- Department of Materials Science and Engineering, National University of Singapore, Singapore, Singapore
| | - Xi Tian
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore
| | - Selman A Kurt
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore
| | - Zhipeng Li
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore
| | - Devika Mukherjee
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Ravisankar Rajarethinam
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore, Singapore
| | - Choon Seng Chong
- Department of Surgery, National University Hospital, Singapore, Singapore
| | - Jiong-Wei Wang
- Cardiovascular Research Institute, National University Heart Centre, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Nanomedicine Translational Research Programme, Centre for NanoMedicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Pui Lai Rachel Ee
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Weiqiang Loke
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Benjamin C K Tee
- Institute for Health Innovation and Technology, National University of Singapore, Singapore, Singapore.,The N.1 Institute for Health, National University of Singapore, Singapore, Singapore.,Department of Materials Science and Engineering, National University of Singapore, Singapore, Singapore
| | - Jianyong Ouyang
- Department of Materials Science and Engineering, National University of Singapore, Singapore, Singapore
| | - Christopher J Charles
- Cardiovascular Research Institute, National University Heart Centre, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - John S Ho
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore. .,Institute for Health Innovation and Technology, National University of Singapore, Singapore, Singapore. .,The N.1 Institute for Health, National University of Singapore, Singapore, Singapore.
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6
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Debs T, Iannelli A, Frey S, Petrucciani N, Korkmaz C, Ben Amor V, Chenaitia H, Vanbiervliet G, Gugenheim J, Ben Amor I. Mesenchymal Stem Cells and Platelet Rich Plasma Therapy to Treat Leak After Sleeve Gastrectomy. J Surg Res 2021; 268:405-410. [PMID: 34416412 DOI: 10.1016/j.jss.2021.06.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/25/2021] [Accepted: 06/29/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND One of the most feared and life-threatening complications after sleeve gastrectomy (SG) is staple line leak, with an incidence between 1 and 4%. Stable patients may be managed conservatively, with antibiotics, percutaneous drainage and endoscopy-based treatment. We propose mesenchymal stem cells (MSC) and platelet rich plasma (PRP) therapy as an innovative technique to treat leak after SG. MATERIAL AND METHODS Bone marrow MSCs is obtained by centrifugation of tibial puncture specimen. A peripheral whole blood sample is retrieved from the patient and centrifuged to obtain PRP. During endoscopy, the first 10 mL are injected in 4quadrants (equal volume) in the submucosae around the internal orifice. The second 10 mL are injected in the wall of the fistula tract. RESULTS The immediate course following the endoscopy was uneventful in both reported cases. The leaks healed in 30 and 42 D, respectively. Oral nutrition was progressively started during the third WK and fourth WK following the injection for both patients. No adverse event was noted during the follow-up period. CONCLUSION The management of fistulas post SG is controversial and actual available treatments present a relatively prolonged healing time. MSC administration retains a high potential value in the treatment of these fistulas. Further studies and wider clinical trials are mandatory to determine the impact of MSC administration.
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Affiliation(s)
- Tarek Debs
- Digestive Surgery and Liver Transplantation Unit, University Hospital of Nice, Nice, France
| | - Antonio Iannelli
- Digestive Surgery and Liver Transplantation Unit, University Hospital of Nice, Nice, France
| | - Sebastien Frey
- Digestive Surgery and Liver Transplantation Unit, University Hospital of Nice, Nice, France
| | - Niccolo Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
| | - Carine Korkmaz
- Digestive Surgery and Liver Transplantation Unit, University Hospital of Nice, Nice, France
| | | | | | | | - Jean Gugenheim
- Digestive Surgery and Liver Transplantation Unit, University Hospital of Nice, Nice, France
| | - Imed Ben Amor
- Digestive Surgery and Liver Transplantation Unit, University Hospital of Nice, Nice, France
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7
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Gjeorgjievski M, Imam Z, Cappell MS, Jamil LH, Kahaleh M. A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks. J Clin Gastroenterol 2021; 55:551-576. [PMID: 33234879 DOI: 10.1097/mcg.0000000000001451] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bariatric surgery leaks result in significant morbidity and mortality. Experts report variable therapeutic approaches, without uniform guidelines or consensus. OBJECTIVE To review the pathogenesis, risk factors, prevention, and treatment of gastric sleeve leaks, with a focus on endoscopic approaches. In addition, the efficacy and success rates of different treatment modalities are assessed. DESIGN A comprehensive review was conducted using a thorough literature search of 5 online electronic databases (PubMed, PubMed Central, Cochrane, EMBASE, and Web of Science) from the time of their inception through March 2020. Studies evaluating gastric sleeve leaks were included. MeSH terms related to "endoscopic," "leak," "sleeve," "gastrectomy," "anastomotic," and "bariatric" were applied to a highly sensitive search strategy. The main outcomes were epidemiology, pathophysiology, diagnosis, treatment, and outcomes. RESULTS Literature search yielded 2418 studies of which 438 were incorporated into the review. Shock and peritonitis necessitate early surgical intervention for leaks. Endoscopic therapies in acute and early leaks involve modalities with a focus on one of: (i) defect closure, (ii) wall diversion, or (iii) wall exclusion. Surgical revision is required if endoscopic therapies fail to control leaks after 6 months. Chronic leaks require one or more endoscopic, radiologic, or surgical approaches for fluid collection drainage to facilitate adequate healing. Success rates depend on provider and center expertise. CONCLUSION Endoscopic management of leaks post sleeve gastrectomy is a minimally invasive and effective alternative to surgery. Their effect may vary based on clinical presentation, timing or leak morphology, and should be tailored to the appropriate endoscopic modality of treatment.
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Affiliation(s)
- Mihajlo Gjeorgjievski
- Departments of Gastroenterology & Hepatology
- Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical Center, New Brunswick, NJ
| | - Zaid Imam
- Departments of Gastroenterology & Hepatology
- Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Mitchell S Cappell
- Departments of Gastroenterology & Hepatology
- Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Laith H Jamil
- Departments of Gastroenterology & Hepatology
- Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Michel Kahaleh
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical Center, New Brunswick, NJ
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8
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Retrospective multicenter study on endoscopic treatment of upper GI postsurgical leaks. Gastrointest Endosc 2021; 93:1283-1299.e2. [PMID: 33075368 DOI: 10.1016/j.gie.2020.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/09/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Therapeutic endoscopy plays a critical role in the management of upper GI (UGI) postsurgical leaks. Data are scarce regarding clinical success and safety. Our aim was to evaluate the effectiveness of endoscopic therapy for UGI postsurgical leaks and associated adverse events (AEs) and to identify factors associated with successful endoscopic therapy and AE occurrence. METHODS This was a retrospective, multicenter, international study of all patients who underwent endoscopic therapy for UGI postsurgical leaks between 2014 and 2019. RESULTS Two hundred six patients were included. Index surgery most often performed was sleeve gastrectomy (39.3%), followed by gastrectomy (23.8%) and esophagectomy (22.8%). The median time between index surgery and commencement of endoscopic therapy was 16 days. Endoscopic closure was achieved in 80.1% of patients after a median follow-up of 52 days (interquartile range, 33-81.3). Seven hundred seventy-five therapeutic endoscopies were performed. Multimodal therapy was needed in 40.8% of patients. The cumulative success of leak resolution reached a plateau between the third and fourth techniques (approximately 70%-80%); this was achieved after 125 days of endoscopic therapy. Smaller leak initial diameters, hospitalization in a general ward, hemodynamic stability, absence of respiratory failure, previous gastrectomy, fewer numbers of therapeutic endoscopies performed, shorter length of stay, and shorter times to leak closure were associated with better outcomes. Overall, 102 endoscopic therapy-related AEs occurred in 81 patients (39.3%), with most managed conservatively or endoscopically. Leak-related mortality rate was 12.4%. CONCLUSIONS Multimodal therapeutic endoscopy, despite being time-consuming and requiring multiple procedures, allows leak closure in a significant proportion of patients with a low rate of severe AEs.
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Bhandari P, Longcroft-Wheaton G, Libanio D, Pimentel-Nunes P, Albeniz E, Pioche M, Sidhu R, Spada C, Anderloni A, Repici A, Haidry R, Barthet M, Neumann H, Antonelli G, Testoni A, Ponchon T, Siersema PD, Fuccio L, Hassan C, Dinis-Ribeiro M. Revising the European Society of Gastrointestinal Endoscopy (ESGE) research priorities: a research progress update. Endoscopy 2021; 53:535-554. [PMID: 33822332 DOI: 10.1055/a-1397-3005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND One of the aims of the European Society of Gastrointestinal Endoscopy (ESGE) is to encourage high quality endoscopic research at a European level. In 2016, the ESGE research committee published a set of research priorities. As endoscopic research is flourishing, we aimed to review the literature and determine whether endoscopic research over the last 4 years had managed to address any of our previously published priorities. METHODS As the previously published priorities were grouped under seven different domains, a working party with at least two European experts was created for each domain to review all the priorities under that domain. A structured review form was developed to standardize the review process. The group conducted an extensive literature search relevant to each of the priorities and then graded the priorities into three categories: (1) no longer a priority (well-designed trial, incorporated in national/international guidelines or adopted in routine clinical practice); (2) remains a priority (i. e. the above criterion was not met); (3) redefine the existing priority (i. e. the priority was too vague with the research question not clearly defined). RESULTS The previous ESGE research priorities document published in 2016 had 26 research priorities under seven domains. Our review of these priorities has resulted in seven priorities being removed from the list, one priority being partially removed, another seven being redefined to make them more precise, with eleven priorities remaining unchanged. This is a reflection of a rapid surge in endoscopic research, resulting in 27 % of research questions having already been answered and another 27 % requiring redefinition. CONCLUSIONS Our extensive review process has led to the removal of seven research priorities from the previous (2016) list, leaving 19 research priorities that have been redefined to make them more precise and relevant for researchers and funding bodies to target.
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Affiliation(s)
- Pradeep Bhandari
- Department of Gastroenterology, Portsmouth University Hospital NHS Trust, Portsmouth, UK
| | | | - Diogo Libanio
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
| | - Pedro Pimentel-Nunes
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
| | - Eduardo Albeniz
- Gastroenterology Department, Endoscopy Unit, Complejo Hospitalario de Navarra, Navarrabiomed-UPNA-IdiSNA, Pamplona, Spain
| | - Mathieu Pioche
- Gastroenterology Division, Edouard Herriot Hospital, Lyon, France
| | - Reena Sidhu
- Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK
| | - Cristiano Spada
- Digestive Endoscopy and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli, Ariccia, Rome, Italy
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Digestive Endoscopy Unit, IRCSS Humanitas Research Hospital, Milan, Italy
| | - Rehan Haidry
- Department of Gastroenterology, University College London Hospitals, London, UK
| | - Marc Barthet
- Department of Gastroenterology, Hôpital Nord, Assistance publique des hôpitaux de Marseille, Marseille, France
| | - Helmut Neumann
- Department of Medicine I, University Medical Center Mainz, Mainz, Germany.,GastroZentrum Lippe, Bad Salzuflen, Germany
| | - Giulio Antonelli
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli, Ariccia, Rome, Italy.,Nuovo Regina Margherita Hospital, Rome, Italy.,Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | | | - Thierry Ponchon
- Gastroenterology Division, Edouard Herriot Hospital, Lyon, France
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Mario Dinis-Ribeiro
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
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10
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Marie L, Robert M, Montana L, De Dominicis F, Ezzedine W, Caiazzo R, Fournel L, Mancini A, Kassir R, Boullu S, Barthet M, D'Journo XB, Bège T. A French National Study on Gastropleural and Gastrobronchial Fistulas After Bariatric Surgery: the Impact of Therapeutic Strategy on Healing. Obes Surg 2021; 30:3111-3118. [PMID: 32382962 DOI: 10.1007/s11695-020-04655-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Gastropleural and gastrobronchial fistulas (GPF/GBFs) are serious but rare complications after bariatric surgery whose management is not consensual. The aim was to establish a cohort and evaluate different clinical presentations and therapeutic options. MATERIALS AND METHODS A multicenter and retrospective study analyzing GPF/GBFs after bariatric surgery in France between 2007 and 2018, via a questionnaire sent to digestive and thoracic surgery departments. RESULTS The study included 24 patients from 9 surgical departments after initial bariatric surgery (21 sleeve gastrectomies; 3 gastric bypass) for morbid obesity (mean BMI = 42 ± 8 kg/m2). The GPF/GBFs occurred, on average, 124 days after bariatric surgery, complicating an initial post-operative gastric fistula (POGF) in 66% of cases. Endoscopic digestive treatment was performed in 79% of cases (n = 19) associated in 25% of cases (n = 6) with thoracic endoscopy. Surgical treatment was performed in 83% of cases (n = 20): thoracic surgery (n = 5), digestive surgery (n = 8), and combined surgery (n = 7). No patient died. Overall morbidity was 42%. The overall success rate of the initial and secondary strategies was 58.5% and 90%, respectively. The average healing time was approximately 7 months. Patients who had undergone thoracic surgery (n = 12) had more initial management failures (n = 9/12) than patients who had not (n = 3/12), p = 0.001. CONCLUSION Complex and life-threatening fistulas that are revealed late require a multidisciplinary strategy. Thoracic surgery should be reserved once the abdominal leak heals; otherwise, it is associated with a higher risk of failure.
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Affiliation(s)
- L Marie
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Chemin des Bourrely, 13915, Marseille Cedex 20, France
| | - M Robert
- Department of Digestive and Bariatric Surgery, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - L Montana
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Digestive and Metabolic Surgery, Avicenne University Hospital, Université Paris XIII, Route de Stalingrad, Bobigny, France
| | - F De Dominicis
- Department of Thoracic Surgery, Amiens University Hospital, Amiens, France
| | - W Ezzedine
- General and Endocrine Surgery Department, Huriez Hospital, Lille University, Lille, France
| | - R Caiazzo
- General and Endocrine Surgery Department, Huriez Hospital, Lille University, Lille, France
| | - L Fournel
- Department of Thoracic Surgery, Paris-Center University Hospital, AP-HP, Paris Descartes University, Paris, France
| | - A Mancini
- Department of thoracic and endocrine surgery, University Hospital of Grenoble, Grenoble, France
| | - R Kassir
- Department of Digestive Surgery, CHU Félix Guyon, Saint Denis, La réunion, France
| | - S Boullu
- Department of Endocrinology, Aix Marseille Univ-APHM-Hôpital Nord, Marseille, France
| | - M Barthet
- Digestive Endoscopy Unit, Gastroenterology Department, Hopital Nord, APHM, Marseille, France
| | - X B D'Journo
- Service de Chirurgie Thoracique, CNRS, INSERM, Centre de Recherche en Cancérologie de Marseille (CRCM), Assistance-Publique Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - Thierry Bège
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Chemin des Bourrely, 13915, Marseille Cedex 20, France.
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11
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Donatelli G, Manos T, Noel P, Dumont JL, Nedelcu A, Nedelcu M. Aortic injuries following stents in bariatric surgery: our experience. Surg Obes Relat Dis 2021; 17:340-344. [DOI: 10.1016/j.soard.2020.09.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/26/2020] [Accepted: 09/14/2020] [Indexed: 12/26/2022]
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12
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Nedelcu M, Manos T, Noel P, Gagner M, Palermo M, Danan M, Nedelcu A, Vilallonga R. Aortic Injuries Following Stent Deployments in Bariatric Surgery-Review of Literature. J Laparoendosc Adv Surg Tech A 2020; 31:171-175. [PMID: 33351718 DOI: 10.1089/lap.2020.0731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction: Consecutive to an increase in the number of bariatric surgeries worldwide, the number of articles reporting complications have also increased. The most dreadful bariatric complication is represented by the leak, and the endoscopic stent is still the standard treatment for some bariatric teams despite the poor quality of life and associated complications. The purpose of this review was to identify the very rare cases of aortic injuries associated with stent use in bariatric surgery. Methods: Aortic injuries related to stent use was the main criteria to summarize the literature by a careful assessment of PubMed/MEDLINE databases. Leak characteristics, primary endoscopic treatment, and the outcome of endoscopic complication were retrieved and categorized from each eligible article. Results: Thirty-five articles were selected for analysis. After abstract analysis, 22 studies were excluded, and 13 articles were reviewed in full-text version. Four articles were confirmed with aortic injury following stent use for complications after different bariatric procedures. These contained one retrospective case series and three retrospective case reports. There were 4 patients involved with complications following bariatric surgery: Roux-en-Y Gastric Bypass-3 cases and laparoscopic sleeve gastrectomy-1 case. The reported mortality of the aorto-esophageal fistula was 50%. Conclusions: Using stents in the treatment of leaks following bariatric surgery could be an efficient treatment, despite the poor quality of life and the stent migration. Even though it is rare, the aortic injury is a dreaded complication related to stent use and associated with high mortality rates.
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Affiliation(s)
- Marius Nedelcu
- Bariatric Unit, ELSAN, Clinique Bouchard, Marseille, France.,Bariatric Unit, ELSAN, Clinique St-Michel, Toulon, France
| | - Thierry Manos
- Bariatric Unit, ELSAN, Clinique Bouchard, Marseille, France
| | - Patrick Noel
- Bariatric Unit, ELSAN, Clinique Bouchard, Marseille, France
| | - Michel Gagner
- Bariatric Unit, Sacre Coeur Hospital, Montreal, Canada
| | - Mariano Palermo
- Division of Bariatric Surgery of DIAGNOMED, Affiliated Institution of the University of Buenos Aires, Buenos Aires, Argentina
| | - Marc Danan
- Bariatric Unit, ELSAN, Clinique St-Michel, Toulon, France
| | | | - Ramon Vilallonga
- Bariatric Unit, ELSAN, Clinique St-Michel, Toulon, France.,Universitat Autònoma de Barcelona, Barcelona, Spain.,Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Hospital Vall d'Hebron, Barcelona, Spain
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Abstract
Gastrointestinal surgery is increasingly being performed. Despite improving technology and outcomes, complications are not completely avoidable. Frequently, surgical complications require invasive procedures for management. However, with increasing availability of flexible endoscopy and a wider array of tools, more often these complications can be managed with an endolumenal approach. This article is an in-depth review of endoscopic management of surgical complications.
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Aljahdli ES, Aldabbagh A, Salah F, Alsahafi M, Maghrabi AA. Endoscopic Management of Post-Laparoscopic Sleeve Gastrectomy Leakage and Stenosis Using Fully Covered Stent. SAUDI JOURNAL OF MEDICINE AND MEDICAL SCIENCES 2020; 9:45-50. [PMID: 33519343 PMCID: PMC7839568 DOI: 10.4103/sjmms.sjmms_347_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/20/2019] [Accepted: 08/20/2020] [Indexed: 11/04/2022] Open
Abstract
Background Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed surgery to treat morbid obesity. Post-LSG leak and stenosis are serious complications that can be associated with significant morbidity and mortality. Objective The objective was to report the efficacy and safety profile of using specifically designed fully covered self-expandable metallic stent for the treatment of post-LSG complications. Methods This retrospective study included adult patients who underwent placement of a fully covered esophagogastric, self-expandable metallic stent for post-LSG leak or stenosis. The procedure was carried out at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between September 2017 and May 2019. Data regarding demographics, indication for stenting, size of the stent, procedural success and poststenting adverse events were collected. Results A total of 14 patients met the inclusion criteria, with indication for endoscopic stenting being post-LSG leak in 11 patients and stenosis in 3 patients. The technical success rate of self-expandable metallic stent placement was 100%, and the clinical success was 85.7% (12 of 14 patients). Nausea (71.4%) and vomiting (85.7%) were the most frequent mild adverse events reported. Stent-induced esophageal stricture was the only major adverse event reported in two patients. Conclusion Placement of specifically designed self-expandable metallic stent for the treatment of post-LSG leak and stenosis is an effective and safe approach. Further studies with larger cohorts are needed to assess the optimal duration needed to treat such complications.
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Affiliation(s)
- Emad S Aljahdli
- Department of Medicine, Division of Gastroenterology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ammar Aldabbagh
- Department of Medicine, Division of Gastroenterology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fatima Salah
- Department of Medicine, Division of Gastroenterology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Majid Alsahafi
- Department of Medicine, Division of Gastroenterology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ashraf A Maghrabi
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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15
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Endoscopic devices and techniques for the management of bariatric surgical adverse events (with videos). Gastrointest Endosc 2020; 92:492-507. [PMID: 32800313 DOI: 10.1016/j.gie.2020.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS As the prevalence of obesity continues to rise, increasing numbers of patients undergo bariatric surgery. Management of adverse events of bariatric surgery may be challenging and often requires a multidisciplinary approach. Endoscopic intervention is often the first line of therapy for management of these adverse events. This document reviews technologies and techniques used for endoscopic management of adverse events of bariatric surgery, organized by surgery type. METHODS The MEDLINE database was searched through May 2018 for articles related to endoscopic management of adverse events of bariatric interventions by using relevant keywords such as adverse events related to "gastric bypass," "sleeve gastrectomy," "laparoscopic adjustable banding," and "vertical banded sleeve gastroplasty," in addition to "endoscopic treatment" and "endoscopic management," among others. Available data regarding efficacy, safety, and financial considerations are summarized. RESULTS Common adverse events of bariatric surgery include anastomotic ulcers, luminal stenoses, fistulae/leaks, and inadequate initial weight loss or weight regain. Devices used for endoscopic management of bariatric surgical adverse events include balloon dilators (hydrostatic, pneumatic), mechanical closure devices (clips, endoscopic suturing system, endoscopic plication platform), luminal stents (covered esophageal stents, lumen-apposing metal stents, plastic stents), and thermal therapy (argon plasma coagulation, needle-knives), among others. Available data, composed mainly of case series and retrospective cohort studies, support the primary role of endoscopic management. Multiple procedures and techniques are often required to achieve clinical success, and existing management algorithms are evolving. CONCLUSIONS Endoscopy is a less invasive alternative for management of adverse events of bariatric surgery and for revisional procedures. Endoscopic procedures are frequently performed in the context of multidisciplinary management with bariatric surgeons and interventional radiologists. Treatment algorithms and standards of practice for endoscopic management will continue to be refined as new dedicated technology and data emerge.
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16
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Galvez A, King K, El Chaar M, Matin A, Claros L. A Curious Case of a Staple Line Leak Presenting 18 Months After Sleeve Gastrectomy: Our Management Approach. Obes Surg 2020; 31:421-423. [PMID: 32617924 DOI: 10.1007/s11695-020-04825-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Alvaro Galvez
- St Luke's Weight Management Center, St Luke's University Health Network, North 240 Cetronia Rd, Allentown, PA, USA.
| | - Keith King
- St Luke's Weight Management Center, St Luke's University Health Network, North 240 Cetronia Rd, Allentown, PA, USA
| | - Maher El Chaar
- St Luke's Weight Management Center, St Luke's University Health Network, North 240 Cetronia Rd, Allentown, PA, USA
| | - Ayaz Matin
- St Luke's Weight Management Center, St Luke's University Health Network, North 240 Cetronia Rd, Allentown, PA, USA
| | - Leonardo Claros
- St Luke's Weight Management Center, St Luke's University Health Network, North 240 Cetronia Rd, Allentown, PA, USA
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17
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Endoscopic internal drainage by double pigtail stents in the management of laparoscopic sleeve gastrectomy leaks. Surg Obes Relat Dis 2020; 16:831-838. [DOI: 10.1016/j.soard.2020.03.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 12/17/2022]
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Balagué C, Fernandez-Ananín S, Ibarzabal A, París M, Vilallonga R, Puche JJ, Ruiz de Adana JC. The role of endoprostheses in the treatment of leaks after laparoscopic sleeve gastrectomy. Analysis of a Spanish registry. Cir Esp 2020; 98:373-380. [PMID: 32600648 DOI: 10.1016/j.ciresp.2020.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/25/2019] [Accepted: 02/24/2020] [Indexed: 11/16/2022]
Abstract
It has been suggested that endoprostheses are an effective treatment for fistulae after sleeve gastrectomy, but the results published are very variable. To analyze the effectiveness of stents as treatment of leakage after sleeve gastrectomy, the Spanish Society of Obesity Surgery (SECO) and the Obesity Division of the Spanish Association of Surgeons (AEC) set up a National Registry to record treatments of leaks after sleeve gastrectomy. We have analyzed patients with leaks after sleeve gastrectomy and treated with endoprostheses: 19 medical centers reported the use of endoprostheses, where 51 endoprostheses were used in 42 patients (34 women/8 men, mean age: 43.8 years, BMI: 47.6). Global effectiveness was 45%, with a complication rate of 35%. Uni- and multivariate analyses detected no factors influencing the efficacy of treatment. A larger diameter bouggie used to calibrate the stomach was related to a higher incidence of complications. No factors were found related with better stent efficacy. The effectiveness of a second stent was very low when the previous one had not been effective.
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Affiliation(s)
- Carmen Balagué
- Servicio de Cirugía General y Digestiva, Hospital de la Santa Creu i Sant Pau, UAB, Barcelona, España.
| | - Sonia Fernandez-Ananín
- Servicio de Cirugía General y Digestiva, Hospital de la Santa Creu i Sant Pau, UAB, Barcelona, España
| | - Ainitze Ibarzabal
- Servicio de Cirugía General y Digestiva, Hospital Clinic, UB, Barcelona, España
| | - Marta París
- Servicio de Cirugía General y Digestiva, Hospital Sant Joan de Reus, Reus, España
| | - Ramón Vilallonga
- Servicio de Cirugía General y Digestiva, Hospital de la Vall d'Hebron, UAB, Barcelona, España
| | - José Julian Puche
- Servicio de Cirugía General y Digestiva, Hospital General Universitario, Valencia, España
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Endoscopic management of refractory leaks and fistulas after bariatric surgery with long-term follow-up. Surg Endosc 2020; 35:2715-2723. [DOI: 10.1007/s00464-020-07702-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/09/2020] [Indexed: 12/15/2022]
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20
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Piyachaturawat P, Mekaroonkamol P, Rerknimitr R. Use of the Over the Scope Clip to Close Perforations and Fistulas. Gastrointest Endosc Clin N Am 2020; 30:25-39. [PMID: 31739966 DOI: 10.1016/j.giec.2019.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In gastrointestinal perforation or fistula, endoscopic closure techniques could be used as alternatives to surgery. Early endoscopic recognition and treatment of gastrointestinal perforation is the most important factor determining procedural success and clinical outcomes. The over-the-scope clip with full-thickness grasping capability provides greater technical and clinical success rates compared with the through-the-scope clips. Although the technical success rate of chronic fistula closure is comparable to perforation closure, it has a significantly lower clinical success owing to its less healthy tissue edge of the fistula. The over-the-scope clip system should be considered before surgery for the closure of perforation and fistula.
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Affiliation(s)
- Panida Piyachaturawat
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Rama 4 Road, Patumwan, Bangkok 10330, Thailand; Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Chulalongkorn University, Bangkok, Thailand
| | - Parit Mekaroonkamol
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Rama 4 Road, Patumwan, Bangkok 10330, Thailand; Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Chulalongkorn University, Bangkok, Thailand
| | - Rungsun Rerknimitr
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Rama 4 Road, Patumwan, Bangkok 10330, Thailand; Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Chulalongkorn University, Bangkok, Thailand.
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Diaz R, Welsh LK, Perez JE, Narvaez A, Davalos G, Portenier D, Guerron AD. Endoscopic septotomy as a treatment for leaks after sleeve gastrectomy: Meeting presentations: Digestive Disease Week 2019. Endosc Int Open 2020; 8:E70-E75. [PMID: 31921987 PMCID: PMC6949161 DOI: 10.1055/a-1027-6888] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/12/2019] [Indexed: 12/16/2022] Open
Abstract
Background and study aims Sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure in the world. Leaks are the most feared complications after this procedure. Endoscopic septotomy has been described as a resolution technique that could be useful in the setting of late and chronic leaks. We present our experience in the management of gastric leaks with this advanced endoscopic technique. Patients and methods Retrospective review of patients who have been admitted to our hospital from January 2016 to December 2018. Results Five patients were found. All had their index surgery in outside hospitals. The average age was 51 years (range 40 - 69), and four patients were female. Mean time from LSG to leak presentation was 15 days (range 7 - 25). Mean time from leak presentation to septotomy procedure was 61 days (range 21 - 110). All patients were treated with sleeve dilatation before septotomy using endoscopic achalasia balloons. Mean procedure time was 79 minutes (range 55 - 125). Success was achieved in 80 % of patients, and no complications related to the procedure were identified. One patient underwent total gastrectomy for definitive management. Mean follow-up time was 14.25 months (range 6 - 26), and the average time for fistula closure was 60.25 days. Conclusion Endoscopic septotomy is safe and effective for management of chronic leaks after LSG. Associated non-selective dilatation may be a crucial step to allow distal patency and axis rectification for appropriate leak closure.
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Affiliation(s)
- Ramon Diaz
- Division of Minimally Invasive Surgery, Metabolic and Weight Loss Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina, United States
| | - Leonard K. Welsh
- Division of Minimally Invasive Surgery, Metabolic and Weight Loss Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina, United States
| | - Juan Esteban Perez
- Division of Minimally Invasive Surgery, Metabolic and Weight Loss Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina, United States
| | - Andres Narvaez
- Division of Minimally Invasive Surgery, Metabolic and Weight Loss Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina, United States
| | - Gerardo Davalos
- Division of Minimally Invasive Surgery, Metabolic and Weight Loss Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina, United States
| | - Dana Portenier
- Division of Minimally Invasive Surgery, Metabolic and Weight Loss Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina, United States
| | - A. Daniel Guerron
- Division of Minimally Invasive Surgery, Metabolic and Weight Loss Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina, United States
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22
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Efficacy and feasibility of OverStitch suturing of leaks in the upper gastrointestinal tract. Surg Endosc 2019; 34:3861-3869. [DOI: 10.1007/s00464-019-07152-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 09/24/2019] [Indexed: 02/06/2023]
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Okazaki O, Bernardo WM, Brunaldi VO, Junior CCDC, Minata MK, de Moura DTH, de Souza TF, Campos JM, Santo MA, de Moura EGH. Efficacy and Safety of Stents in the Treatment of Fistula After Bariatric Surgery: a Systematic Review and Meta-analysis. Obes Surg 2019; 28:1788-1796. [PMID: 29654447 DOI: 10.1007/s11695-018-3236-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Fistula development is a serious complication after bariatric surgery. We performed a systematic review and meta-analysis to assess the efficacy of fistula closure and complications associated with endoscopic stent treatment of fistulas, developed after bariatric surgeries, particularly Roux-en-Y gastric bypass (RYGB) and gastric sleeve (GS). Studies involving patients with fistula after RYGB or GS and those who received stent treatment only were selected. The analyzed outcomes were overall success rate of fistula closure, mean number of stents per patient, mean stent dwelling time, and procedure-associated complications. Current evidence from identified studies demonstrates that, in selected patients, endoscopic stent treatment of fistulas after GS or RYGB can be safe and effective.
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Affiliation(s)
- Ossamu Okazaki
- Gastrointestinal Endoscopy Unit, Hospital das Clinicas, University of São Paulo Medical School, Dr. Arnaldo Av, 255., São Paulo, 01246-903, Brazil.
| | - Wanderley M Bernardo
- Gastrointestinal Endoscopy Unit, Hospital das Clinicas, University of São Paulo Medical School, Dr. Arnaldo Av, 255., São Paulo, 01246-903, Brazil
| | - Vitor O Brunaldi
- Gastrointestinal Endoscopy Unit, Hospital das Clinicas, University of São Paulo Medical School, Dr. Arnaldo Av, 255., São Paulo, 01246-903, Brazil
| | - Cesar C de Clemente Junior
- Gastrointestinal Endoscopy Unit, Hospital das Clinicas, University of São Paulo Medical School, Dr. Arnaldo Av, 255., São Paulo, 01246-903, Brazil
| | - Maurício K Minata
- Gastrointestinal Endoscopy Unit, Hospital das Clinicas, University of São Paulo Medical School, Dr. Arnaldo Av, 255., São Paulo, 01246-903, Brazil
| | - Diogo T H de Moura
- Gastrointestinal Endoscopy Unit, Hospital das Clinicas, University of São Paulo Medical School, Dr. Arnaldo Av, 255., São Paulo, 01246-903, Brazil
| | - Thiago F de Souza
- Gastrointestinal Endoscopy Unit, Hospital das Clinicas, University of São Paulo Medical School, Dr. Arnaldo Av, 255., São Paulo, 01246-903, Brazil
| | | | - Marco Aurélio Santo
- Bariatric and Metabolic Surgery Unit, Hospital das Clinicas, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Eduardo G H de Moura
- Gastrointestinal Endoscopy Unit, Hospital das Clinicas, University of São Paulo Medical School, Dr. Arnaldo Av, 255., São Paulo, 01246-903, Brazil
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Abstract
Background and Aims Therapeutic endoscopy plays a major role in the management of postbariatric anastomotic leaks, offering an effective treatment alternative to repeated surgery. In recent years, management has been moving from bridging and closing the leak’s orifice toward an approach that uses vacuum therapy or internal drainage. Our aim was to demonstrate different treatment options for the management of postbariatric leaks. Methods We describe 3 different endoscopic techniques for postbariatric leaks in 2 patients who had undergone Roux-en-Y gastric bypass (RYGB) and 1 patient who had undergone sleeve gastrectomy. Results The first patient had a 20-mm early post-RYGB leak with an intra-abdominal associated collection treated with 5 sessions of endoscopic vacuum therapy (EVT). The second patient had a 12-mm acute postgastric sleeve leak with an associated collection, in whom therapy with EVT had failed, and who was then treated with endoscopic internal drainage (EID). The last patient had a chronic intra-abdominal collection after RYGB, despite reoperation, in whom therapy with EID and esophageal stent had failed, and who was treated with a diabolo-shaped lumen-apposing metal stent placed between the gastric pouch and the gastric remnant. Weight-loss intention was not compromised in any patient. All patients remain well. Conclusions Staple-line or anastomotic leaks are an important cause of morbidity and mortality after surgery. There are myriad endoscopic techniques, with varying reported efficacy. Often, more than one endoscopic approach can be used concomitantly, whereas in other cases, therapies are applied sequentially depending on the initial clinical response. Multiple therapeutic options should be considered before endoscopic failure.
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Sousa P, Noronha Ferreira C, Coutinho J, Carepa F, Rosa R, Barão A, Marques Ferreira C, Girao J, Ruivo A, Bicha Castelo H, Lopes J, Almeida A, Carrilho Ribeiro L, Velosa J. Fistula Recurrence: A Clinical Reality after Successful Endoscopic Closure of Laparoscopic Sleeve Gastrectomy Fistulas. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2019; 26:242-250. [PMID: 31328138 DOI: 10.1159/000492637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/31/2018] [Indexed: 11/19/2022]
Abstract
Background and Aims Laparoscopic sleeve gastrectomy (LSG)-related fistulas are important and potentially fatal complications. We aimed at determining the incidence, predictive factors, and management of recurrence of post-LSG fistulas. Methods This is a retrospective cohort study of 12 consecutive patients with LSG fistulas managed endoscopically between 2008 and 2013. We analyzed factors associated with recurrence of post-LSG fistulas and the efficacy of a primarily endoscopic approach to manage fistula recurrence. Results The average age at fistula detection after LSG was 43.3 ± 10.9 years, and 10 (83%) patients were female. The median interval between surgery and initial fistula detection was 14 (4-145) days. Fistulas were located at the gastric cardia in 9/12 patients. A median of 4 (1-10) endoscopies were performed per patient until all fistulas were successfully closed. The median follow-up was 30.5 (15-72) months. Fistula recurrence was detected in 3 (25%) female patients with an average age of 31.7 ± 7.9 years after a median of 119 (50-205) days of the initial fistula closure. Fistulas in all 3 patients recurred at the gastric cardia and were successfully managed endoscopically. There was a second recurrence in 1 patient after 6 months, and she was re-operated with anastomosis of a jejunal loop at the site of the fistula orifice at the gastric cardia. We did not find any factors at initial fistula detection that were significantly associated with fistula recurrence. There were no deaths related to initial fistula after LSG and fistula recurrence. Conclusions A primarily endoscopic approach is an effective and safe method for the management of fistulas after LSG. Fistula recurrence occurred in 25% of patients and was managed endoscopically. Key Messages Although we could not define predictive factors of post-LSG fistula recurrence, it is a clinical reality and can be managed endoscopically.
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Affiliation(s)
- Patricia Sousa
- Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Carlos Noronha Ferreira
- Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - João Coutinho
- Serviço de Cirurgia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Fátima Carepa
- Serviço de Cirurgia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Rosário Rosa
- Serviço de Cirurgia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Andreia Barão
- Serviço de Cirurgia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Carlos Marques Ferreira
- Serviço de Cirurgia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - José Girao
- Serviço de Cirurgia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - António Ruivo
- Serviço de Cirurgia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Henrique Bicha Castelo
- Serviço de Cirurgia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - João Lopes
- Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Amélia Almeida
- Serviço de Anestesiologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Luís Carrilho Ribeiro
- Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - José Velosa
- Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
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Loo GH, Rajan R, Nik Mahmood NRK. Staple-line leak post primary sleeve gastrectomy. A two patient case series and literature review. Ann Med Surg (Lond) 2019; 44:72-76. [PMID: 31321031 PMCID: PMC6614113 DOI: 10.1016/j.amsu.2019.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/07/2019] [Accepted: 06/26/2019] [Indexed: 02/07/2023] Open
Abstract
There is an increasing trend in the number of bariatric surgeries performed worldwide, partly because bariatric surgery is the most effective treatment for morbid obesity. Sleeve gastrectomy (SG) remains the most common bariatric surgery procedure performed, representing more than 50% of all primary bariatric interventions. Major surgical complications of SG include staple-line bleeding, leaking, and stenosis. A leak along the staple-line most commonly occurs at the gastroesophageal junction (GOJ). From January 2018 to December 2018, our centre performed 226 bariatric procedures, of which, 97.8% were primary bariatric procedures. The mean age and BMI were 38.7±8.3 years and 44 kg/m2, respectively. Out of the 202 primary SG performed, we encountered two cases of a staple-line leak (0.99%). This is the first reported case series of SG leaks from the Southeast Asia region. A summary of their characteristics, clinical presentation, subsequent management, and the outcome is discussed. Based on the latest available evidence from the literature, several methods may decrease staple-line leaks in SG. These include the use of a bougie size greater than 40 Fr, routine use of methylene blue test during surgery, beginning transection at 2-6 cm from the pylorus, mobilising the fundus before transection, and staying away from the GOJ at the last firing. Other methods include the proper alignment of the staple-line, control of staple-line bleeding, and performing staple-line reinforcement. The management of a staple-line leak remains challenging due to limited systematic, evidence-based literature being available. Therefore, a tailored approach is needed to manage this complication.
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Affiliation(s)
- Guo Hou Loo
- Surgical Trainee, Department of General Surgery, Faculty of Medicine, The National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Postcode 56000, Selangor, Malaysia
| | - Reynu Rajan
- Consultant Bariatric Surgeon, Department of Surgery, Faculty of Medicine, The National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Postcode 56000, Selangor, Malaysia
| | - Nik Ritza Kosai Nik Mahmood
- Consultant Upper Gastrointestinal & Bariatric Surgeon, Head of Unit of Upper Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Faculty of Medicine, The National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Postcode 56000, Selangor, Malaysia
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The bigger they are: Video tips and techniques for managing acute care surgery emergencies in the postbariatric surgery patient. J Trauma Acute Care Surg 2019; 87:247-250. [PMID: 31259874 DOI: 10.1097/ta.0000000000002272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lopez Luciano MJ, Then EO, Brana CJ, Ofosu A, Gaduputi V. Spontaneous Gastrojejunal Fistulization after Roux-en-Y Bypass Surgery: A Case Report and Review of Literature. Cureus 2019; 11:e5035. [PMID: 31501727 PMCID: PMC6721868 DOI: 10.7759/cureus.5035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Fistula development is an uncommon but well-recognized complication following Roux-en-Y gastric bypass (RYGB). The broad spectrum of clinical presentation represents a challenge at the time of diagnosis. We present the case of a patient who developed gastrojejunal fistulization after gastric bypass surgery.
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Affiliation(s)
| | - Eric O Then
- Internal Medicine, St. Barnabas Hospital Health System, Bronx, USA
| | | | - Andrew Ofosu
- Internal Medicine: Gastroenterology, The Brooklyn Hospital Center, Affiliate of the Mount Sinai Hospital, New York, USA
| | - Vinaya Gaduputi
- Internal Medicine, St. Barnabas Hospital Health System, Bronx, USA
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Comment on "Incidence and efficacy of Stent Placement in Leak Management After Bariatric Surgery: an MBSAQIP Analysis". Ann Surg 2019; 270:e82-e83. [PMID: 31188227 DOI: 10.1097/sla.0000000000003243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Siddiqi S, Schraufnagel DP, Siddiqui HU, Javorski MJ, Mace A, Elnaggar AS, Elgharably H, Vargo PR, Steffen R, Hasan SM, Raja S. Recent advancements in the minimally invasive management of esophageal perforation, leaks, and fistulae. Expert Rev Med Devices 2019; 16:197-209. [PMID: 30767693 DOI: 10.1080/17434440.2019.1582329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Historically, the gold standard management of esophageal perforations, leaks, and fistulae has been traditional open surgery, but it is associated with significant morbidity and mortality. Minimally invasive approaches offer alternatives to surgery in treating hemodynamically stable patients with such defects. In this review article, we will discuss the recent advancements in the minimally invasive management of esophageal perforations, leaks, and fistulas. AREAS COVERED This review includes information from case reports, case series, and clinical trials on minimally invasive management of esophageal perforations, leaks, and fistulas. The focus is on the devices, outcomes, and application of the technology. EXPERT COMMENTARY Minimally invasive treatment represents significant progress in the management of esophageal perforations, leaks, and fistulas. Based on current evidence, it seems safe and effective but it is evolving and more studies are needed to help draw definitive conclusions.
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Affiliation(s)
- Shirin Siddiqi
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Dean P Schraufnagel
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Hafiz Umair Siddiqui
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Michael J Javorski
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Adam Mace
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Abdulrhman S Elnaggar
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Haytham Elgharably
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Patrick R Vargo
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Robert Steffen
- b Department of Cardiovascular Surgery , Minneapolis Heart Institute Foundation , Minneapolis , MN , USA
| | - Saad M Hasan
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Siva Raja
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
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Badurdeen DS, Lamond K, Gandsas A, Kumbhari V. Endoscopic strategies for the treatment of postbariatric surgery leaks and fistulas. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2019. [DOI: 10.1016/j.tgie.2019.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gastroseal: A Novel Stent Design for the Management of Post-Bariatric Surgery Leaks. ACG Case Rep J 2019; 5:e85. [PMID: 30775388 PMCID: PMC6358575 DOI: 10.14309/crj.2018.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 08/21/2018] [Indexed: 11/23/2022] Open
Abstract
Bariatric surgery leaks remain a dreaded complication with ominous consequences. Fully covered stents have shown efficacy in the treatment of leaks; however, stent migration remains a major drawback. Ultra-large stents have shown reduced rates of migration and coapt better against the walls, but deep ulcers occur in almost all patients, as well as frequent severe intolerance, bleeding, and perforation. We have developed a large expandable stent with physical characteristics and a particularly flexible mesh design that make it much less traumatic than conventional large stents while maintaining the advantage of being less prone to migration. In this patient with a post-sleeve gastrectomy leak, we provide a proof of concept that the Gastroseal stent is effective and nontraumatic despite its very large size.
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Oh HJ, Lim CH, Yoon SB, Lee HH, Kim JS, Cho YK, Park JM, Choi MG. Temporary self-expandable metallic stent placement in post-gastrectomy complications. Gastric Cancer 2019; 22:231-236. [PMID: 29761324 DOI: 10.1007/s10120-018-0837-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 05/11/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Self-expandable metallic stents in the upper gastrointestinal tract are used for treating malignant esophageal or gastroduodenal outlet obstructions and fistulas. Recently, self-expandable metallic stent use has been expanded to benign esophageal or gastroduodenal strictures and post-operative complications. However, there is scarce data available regarding efficacy, long-term complications, and outcomes with the use of self-expandable metallic stent in benign disease, especially post-gastrectomy complications. METHODS Data of 57 patients who underwent upper gastrointestinal tract self-expandable metallic stent insertion for post-operative complications between March 2009 and June 2017 were analyzed. All patients underwent a curative gastrectomy for gastric cancer. Data collected included patient demographics, indication for procedure, type of stent used, complications, and patient outcomes. RESULTS Self-expandable metallic stent placement was technically successful in all patients. Of the 57 patients, 33 had self-expandable metallic stent placement for anastomosis site leakage, 12 for anastomosis site refractory stricture, and 12 for obstruction due to angulation. After self-expandable metallic stent placement, symptomatic improvement was achieved in 56 patients (98.2%), among which, three patients (5.4%) had recurrent symptoms, two underwent repeated stent insertion, and one underwent balloon dilatation. After self-expandable metallic stent placement, median time to initiating dietary intake was 6 days (range 1-30 days), and median duration of hospitalization was 13 days (range 3-135 days). At the follow-up (mean 24.6 months), migration was the most commonly reported complication, which developed in 15 (26.3%) patients. CONCLUSIONS Self-expandable metallic stent placement is an effective and safe treatment for post-gastrectomy anastomosis site leakage, stricture, and obstruction, which can decrease the risk of reoperation related mortality and modalities.
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Affiliation(s)
- Hyun Jin Oh
- Center for Cancer Prevention and Detection, National Cancer Center, Goyang, Gyeonggi, Republic of Korea
| | - Chul-Hyun Lim
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea.
| | - Seung Bae Yoon
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea
| | - Han Hee Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea
| | - Jin Su Kim
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea
| | - Yu Kyung Cho
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea
| | - Jae Myung Park
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea
| | - Myung-Gyu Choi
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea
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Kim SH, Keum B, Choi HS, Kim ES, Seo YS, Jeen YT, Lee HS, Chun HJ, Um SH, Kim CD, Park S. Self-expandable metal stents in patients with postoperative delayed gastric emptying after distal gastrectomy. World J Gastroenterol 2018; 24:4578-4585. [PMID: 30386107 PMCID: PMC6209569 DOI: 10.3748/wjg.v24.i40.4578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/11/2018] [Accepted: 10/05/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the efficacy and safety of endoscopic stent insertion in patients with delayed gastric emptying after gastrectomy.
METHODS In this study, we prospectively collected data from patients who underwent stent placement for delayed gastric emptying (DGE) after distal gastrectomy between June 2010 and April 2017, at a tertiary referral academic center. Clinical improvement, complications, and consequences after stent insertion were analyzed.
RESULTS Technical success was achieved in all patients (100%). Early symptom improvement was observed in 15 of 20 patients (75%) and clinical success was achieved in all patients. Mean follow-up period was 1178.3 ± 844.1 d and median stent maintenance period was 51 d (range 6-2114 d). During the follow-up period, inserted stents were passed spontaneously per rectum without any complications in 14 of 20 patients (70%). Symptom improvement was maintained after stent placement without the requirement of any additional intervention in 19 of 20 patients (95%).
CONCLUSION Endoscopic stent placement provides prompt relief of obstructive symptoms. Thus, it can be considered an effective and safe salvage technique for post-operative DGE.
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Affiliation(s)
- Seung Han Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Bora Keum
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Eun Sun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Yeon Seok Seo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Yoon Tae Jeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Hong Sik Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Hoon Jai Chun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Soon Ho Um
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Chang Duck Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Sungsoo Park
- Division of Upper GI Surgery, Department of Surgery, Korea University College of Medicine, Seoul 02841, South Korea
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Endoscopic Management of Post-bariatric Surgery Fistula: a Tertiary Care Center Experience. Obes Surg 2018; 28:3910-3915. [DOI: 10.1007/s11695-018-3432-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Siddiq G, Aziz W, Khizar S, Haider MI, Razzaq A, Ahmad Z, Nadeem M, Nazar CMJ. Laparoscopic Sleeve Gastrectomy: To Suture or not to Suture Staple Line? Cureus 2018; 10:e2992. [PMID: 30237951 PMCID: PMC6141218 DOI: 10.7759/cureus.2992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective To assess the outcome and safety of staple line over-sewing for patients undergoing laparoscopic sleeve gastrectomy (LSG). Study design and location Retrospective descriptive analysis conducted at Shifa International Hospital Islamabad. Materials and methods Consecutive patients undergoing LSG as a treatment for morbid obesity from October 2013 to December 2016 were included in the study after approval from the ethical review board. Patients were divided into two groups: group A who underwent reinforcement using Vicryl 2.0 and group B where no reinforcement was done. Results A total of 225 patients underwent LSG between October 2013 and December 2016, including 147 females (65.4%) and 78 males (34.6%). Both groups were comparable in terms of age, body mass index (BMI) and gender distribution (p-value more than 0.05). There was one leak in group A (1.36%), none in group B. The bleeding rate was 4.3% in group A and 2.7% in group B. Conclusion This was a retrospective analysis of all the patients who underwent LSG, and it was observed that there was no added benefit of sewing the staple line in terms of rate of bleeding and leak.
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Affiliation(s)
- Ghulam Siddiq
- General Surgery, Shifa international hospital , Islamabad, PAK
| | - Waqas Aziz
- General Surgery, Shifa International Hospital, Islamabad, PAK
| | - Samina Khizar
- General Surgery, Shifa Internationa Hospital, Islamabad, PAK
| | | | - Aneela Razzaq
- Surgery, Shifa International Hospital, Islamabad, PAK
| | - Zahid Ahmad
- Nephrology, Shifa International Hospital, Islamabad, PAK
| | - Mahum Nadeem
- Internal Medicine, Sharif Medical and Dental College, Lahore, PAK
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Gonzalez JM, Lorenzo D, Guilbaud T, Bège T, Barthet M. Internal endoscopic drainage as first line or second line treatment in case of postsleeve gastrectomy fistulas. Endosc Int Open 2018; 6:E745-E750. [PMID: 29876512 PMCID: PMC5988543 DOI: 10.1055/s-0044-101450] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 01/03/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Management of post-sleeve gastrectomy fistulas (PSGF) recently has evolved, resulting in prioritization of internal endoscopic drainage (IED). We report our experience with the technique in a tertiary center. PATIENTS AND METHODS This was a single-center, retrospective study of 44 patients whose PSGF was managed with IED, comparing two periods: after 2013 (Group 1; n = 22) when IED was used in first line and before 2013 (Group 2; n = 22) when IED was applied in second line. Demographic data, pre-endoscopic management, characteristics of fistulas, therapeutic modalities and outcomes were recorded and compared between the two groups. The primary endpoint was IED efficacy; the secondary endpoint was a comparison of outcomes depending on the timing of IED in the management strategy. RESULTS The groups were matched in gender (16 female, 16 male), mean age (43 years old), severity of fistula, delay before treatment, and exposure to previous endoscopic or surgical treatments. The overall efficacy rate was 84 % (37/44): 86 % in Group 1 and 82 % in Group 2 (NS). There was one death and one patient who underwent surgery. The median time to healing was 226 ± 750 days (Group 1) vs. 305 ± 300 days (Group 2) (NS), with a median number of endoscopies of 3 ± 6 vs . 4.5 ± 2.4 (NS). There were no differences in number of nasocavity drains and double pigtail stents (DPS), but significantly more metallic stents, complications, and secondary strictures were seen in Group 2. CONCLUSION IED for management of PSGF is effective in more than 80 % of cases whenever it is used during the therapeutic strategy. This approach should be favored when possible.
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Affiliation(s)
- J. M. Gonzalez
- Aix-Marseille Univ, APHM, Service de gastroentérologie, Hôpital Nord, Marseille, France,Corresponding author Jean-Michel Gonzalez, MD, MSc Service de GastroentérologieHôpital Nord, AP-HMChemin des Bourrelys13015, MarseilleFrance+04 91 96 87 37
| | - D. Lorenzo
- Aix-Marseille Univ, APHM, Service de gastroentérologie, Hôpital Nord, Marseille, France
| | - T. Guilbaud
- Aix-Marseille Univ, APHM, Service de chirurgie digestive, Hôpital Nord, Marseille, France
| | - T. Bège
- Aix-Marseille Univ, APHM, Service de chirurgie digestive, Hôpital Nord, Marseille, France
| | - M. Barthet
- Aix-Marseille Univ, APHM, Service de gastroentérologie, Hôpital Nord, Marseille, France
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Kim SY, Oh KY, Chung JW, Kim YJ, Kim KO, Kwon KA, Park DK, Kim KK, Kim SM. Endoscopic Treatment of Diverse Complications Caused by Laparoscopic Adjustable Gastric Banding: A Study in Eastern Asia. Gut Liver 2018; 11:497-503. [PMID: 28335099 PMCID: PMC5491084 DOI: 10.5009/gnl16089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 05/07/2016] [Accepted: 10/13/2016] [Indexed: 01/16/2023] Open
Abstract
Background/Aims The use of laparoscopic adjustable gastric banding (LAGB) is increasing proportionally with the obesity epidemic. However, some postoperative complications have been highlighted as major problems associated with LAGB. There is no consensus concerning the endoscopic management of these adverse events. The aim of this study was to retrospectively review the feasibility and effectiveness of endoscopic treatment for LAGB complications. Methods We retrospectively evaluated 352 patients who underwent LAGB between 2011 and 2015. LAGB-associated complications developed in 26 patients (7.4%). This study involved six patients (1.7%) who received endoscopic treatment. Results Types of LAGB-induced complications in our series included intragastric migration (n=3), gastric leaks (n=2), and gastric fistulas (n=1). The endoscopic treatment of these complications was successful in four of the six patients. Endoscopic band removal was successful in two patients. All gastric leaks were successfully closed via an endoscopic procedure. In two cases (intragastric migration and gastric fistula), endoscopic treatment was not sufficient, and surgery was performed. Conclusions Endoscopic procedures afforded acceptable treatment of band migration and gastric leaks after LAGB. However, the results were poor in patients with gastric fistula.
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Affiliation(s)
- Su Young Kim
- Divison of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Kyong Yong Oh
- Divison of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jun-Won Chung
- Divison of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Yoon Jae Kim
- Divison of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Kyoung Oh Kim
- Divison of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Kwang An Kwon
- Divison of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Dong Kyun Park
- Divison of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Kyoung Kon Kim
- Department of Family Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Seong Min Kim
- Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea
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Martin del Campo SE, Mikami DJ, Needleman BJ, Noria SF. Endoscopic stent placement for treatment of sleeve gastrectomy leak: a single institution experience with fully covered stents. Surg Obes Relat Dis 2018; 14:453-461. [DOI: 10.1016/j.soard.2017.12.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 12/04/2017] [Accepted: 12/15/2017] [Indexed: 12/12/2022]
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Lee SR, Kim HO, Park JH, Yoo CH. Clinical Outcomes of Endoscopic Metal Stent Placement for Esophagojejunostomy Leakage After Total Gastrectomy for Gastric Adenocarcinoma. Surg Laparosc Endosc Percutan Tech 2018; 28:113-117. [DOI: 10.1097/sle.0000000000000513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lorenzo D, Guilbaud T, Gonzalez JM, Benezech A, Dutour A, Boullu S, Berdah S, Bège T, Barthet M. Endoscopic treatment of fistulas after sleeve gastrectomy: a comparison of internal drainage versus closure. Gastrointest Endosc 2018; 87:429-437. [PMID: 28750839 DOI: 10.1016/j.gie.2017.07.032] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 07/19/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Fistulas after sleeve gastrectomy are major adverse events of bariatric surgery. The endoscopic management strategy evolved from closure to internal drainage after 2013. The main objective of our study was to evaluate and compare these different approaches. METHODS This retrospective study included all patients treated for fistulas after sleeve gastrectomy in a referral center. Closure management was defined as initial treatment that used a covered metal stent and/or endoclips. Internal drainage management was defined as initial treatment by nasocystic drain and/or a double-pigtail stent. RESULTS A total of 100 patients (women N = 78, mean [± standard deviation {SD}] age 42 ± 12 years) were included between 2007 and 2015. The mean (± SD) delay between sleeve gastrectomy and the first endoscopy was 82 ± 125 days. The overall success of endoscopic treatment was 86% within 6 ± 27 months. Two patients died. The primary success of internal drainage and closure management occurred in 19 of 22 (86%) and 49 of 77 (63%) patients, respectively. Among patients in failure for closure management, 22 had secondary internal drainage (18 being successful). Success of initial management was significantly higher for internal drainage (P = .043). Factors associated with failure of closure management were in multivariable analysis: collection >5 cm (P = .013). Factors associated with a time >6 months for achieving leakage closure were in multivariable analysis: reoperation before endoscopy (P = .044) and purulent flow at endoscopy (P = .043). CONCLUSIONS Endoscopic management of fistulas after sleeve gastrectomy was successful in 86% of cases. In cases of collections >5 cm, internal drainage should be proposed first. Surgical reintervention before endoscopy delays treatment success.
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Affiliation(s)
- Diane Lorenzo
- Department of Gastroenterology, Aix Marseille Univ-APHM-Hôpital Nord, Marseille, France
| | - Théophile Guilbaud
- Department of Visceral Surgery, Aix Marseille Univ-APHM-Hôpital Nord, Marseille, France
| | - Jean Michel Gonzalez
- Department of Gastroenterology, Aix Marseille Univ-APHM-Hôpital Nord, Marseille, France
| | - Alban Benezech
- Department of Gastroenterology, Aix Marseille Univ-APHM-Hôpital Nord, Marseille, France
| | - Anne Dutour
- Department of Endocrinology, Aix Marseille Univ-APHM-Hôpital Nord, Marseille, France
| | - Sandrine Boullu
- Department of Endocrinology, Aix Marseille Univ-APHM-Hôpital Nord, Marseille, France
| | - Stéphane Berdah
- Department of Visceral Surgery, Aix Marseille Univ-APHM-Hôpital Nord, Marseille, France
| | - Thierry Bège
- Department of Visceral Surgery, Aix Marseille Univ-APHM-Hôpital Nord, Marseille, France
| | - Marc Barthet
- Department of Gastroenterology, Aix Marseille Univ-APHM-Hôpital Nord, Marseille, France
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Gastroseal: A Novel Stent Design for the Management of Post-Bariatric Surgery Leaks. ACG Case Rep J 2018. [DOI: 10.14309/02075970-201805120-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Shehab H. Enteral stents in the management of post-bariatric surgery leaks. Surg Obes Relat Dis 2017; 14:393-403. [PMID: 29428690 DOI: 10.1016/j.soard.2017.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 12/10/2017] [Accepted: 12/13/2017] [Indexed: 02/07/2023]
Abstract
A post-bariatric surgery leak is a rare but grave condition and remains every bariatric surgeon's nightmare. Endoscopic therapy with the insertion of self-expandable stents provides an effective minimally invasive approach for the management of leaks. Self-expandable stents, however, are still hampered by their tendency for migration and are not always well tolerated. Recently, double-pigtail stents have been proposed as an alternative endoscopic therapeutic modality. Both types of stents have been shown to be very effective in the management of leaks; however, most studies have pooled gastrointestinal leaks due to different etiologies together. In this article, we review the current status and foreseen innovations in gastrointestinal stenting for post-bariatric surgery leaks.
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Affiliation(s)
- Hany Shehab
- Gastrointestinal Endoscopy unit, Department of Gastroenterology, Cairo University, Cairo, Egypt.
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Docimo S, Svestka M. Endoscopic Evaluation and Treatment of Postoperative Bariatric Surgery Complications. Surg Innov 2017; 24:616-624. [PMID: 29072533 DOI: 10.1177/1553350617736651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The number of patients undergoing bariatric surgery continues to increase. The American Society for Metabolic and Bariatric Surgery (ASMBS) estimates the number of bariatric surgical procedures performed increased from 158 000 in 2011 to 190 000 in 2015. Concurrently, the incidence of postoperative complications specific to bariatric patients will inevitably increase as well. Endoscopic evaluation of postoperative bariatric patients and endoscopic interventions are rapidly evolving. We present a review of the postoperative anatomy of bariatric patients, what complications to expect, and treatment options.
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Shehab H, Abdallah E, Gawdat K, Elattar I. Large Bariatric-Specific Stents and Over-the-Scope Clips in the Management of Post-Bariatric Surgery Leaks. Obes Surg 2017; 28:15-24. [DOI: 10.1007/s11695-017-2808-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Wu G, Yin M, Zhao YS, Fang Y, Zhao G, Zhao J, Han X. Novel esophageal stent for treatment of cervical anastomotic leakage after esophagectomy. Surg Endosc 2017; 31:5024-5031. [PMID: 28432462 DOI: 10.1007/s00464-017-5545-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 03/28/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Dedicated stents for treatment of cervical anastomotic leakage are currently unavailable. In this study, we aimed to assess the feasibility and efficacy of using custom-designed stents for treatment of cervical anastomotic leakage after esophagectomy. METHODS The stents were designed according to the location and size of the leakage and the residual esophageal length as determined by esophagography in each case. It had a cup-shaped upper end and a globular lower end and a total height of 60-85 mm. The diameter of the upper cup-shaped part was 24-26 mm and the length 20-25 mm. The cup part and the stent main body were connected at a right angle. Data from cervical anastomotic leakage patients treated with these stents were retrospectively analyzed. RESULTS Data from a total of 27 patients with cervical anastomotic leakage were retrospectively analyzed. The custom-designed esophageal covered stents were placed successfully at the first attempt in 24 cases (88.9%). The total operative time was 5-15 min. The stents were removed 7 days to 3 months after leakage healing. Follow-up showed no leakage recurrence; three patients had anastomosis scar strictures. Fifteen patients died (median survival 13.4 months) and nine survived. CONCLUSION Placement of the novel esophageal covered stent is a minimally invasive, efficacious treatment option for the patients with cervical anastomotic leakage after esophagectomy.
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Affiliation(s)
- Gang Wu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Meipan Yin
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Yan Shi Zhao
- Division of Gastroenterology and Hepatology, Department of Medicine, Loma Linda University Medical Center, Loma Linda, CA, 92354, USA
| | - Yi Fang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Gaofeng Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Jia Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
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Devaraj P, Gavini H. Endoscopic management of postoperative fistulas and leaks. GASTROINTESTINAL INTERVENTION 2017. [DOI: 10.18528/gii160032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Prathab Devaraj
- Department of Gastroenterology, Hepatology, and Nutrition, Banner University Medical Center, Tucson, AZ, USA
| | - Hemanth Gavini
- Department of Gastroenterology, Hepatology, and Nutrition, Banner University Medical Center, Tucson, AZ, USA
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Souto-Rodríguez R, Alvarez-Sánchez MV. Endoluminal solutions to bariatric surgery complications: A review with a focus on technical aspects and results. World J Gastrointest Endosc 2017; 9:105-126. [PMID: 28360973 PMCID: PMC5355758 DOI: 10.4253/wjge.v9.i3.105] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 10/12/2016] [Accepted: 12/14/2016] [Indexed: 02/06/2023] Open
Abstract
Obesity is a growing problem in developed countries, and surgery is the most effective treatment in terms of weight loss and improving medical comorbidity in a high proportion of obese patients. Despite the advances in surgical techniques, some patients still develop acute and late postoperative complications, and an endoscopic evaluation is often required for diagnosis. Moreover, the high morbidity related to surgical reintervention, the important enhancement of endoscopic procedures and technological innovations introduced in endoscopic equipment have made the endoscopic approach a minimally-invasive alternative to surgery, and, in many cases, a suitable first-line treatment of bariatric surgery complications. There is now evidence in the literature supporting endoscopic management for some of these complications, such as gastrointestinal bleeding, stomal and marginal ulcers, stomal stenosis, leaks and fistulas or pancreatobiliary disorders. However, endoscopic treatment in this setting is not standardized, and there is no consensus on its optimal timing. In this article, we aim to analyze the secondary complications of the most expanded techniques of bariatric surgery with special emphasis on those where more solid evidence exists in favor of the endoscopic treatment. Based on a thorough review of the literature, we evaluated the performance and safety of different endoscopic options for every type of complication, highlighting the most recent innovations and including comparative data with surgical alternatives whenever feasible.
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Montuori M, Benavoli D, D'Ugo S, Di Benedetto L, Bianciardi E, Gaspari AL, Gentileschi P. Integrated Approaches for the Management of Staple Line Leaks following Sleeve Gastrectomy. J Obes 2017; 2017:4703236. [PMID: 28261497 PMCID: PMC5312046 DOI: 10.1155/2017/4703236] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 01/05/2017] [Indexed: 02/06/2023] Open
Abstract
Introduction. Aim of the study was trying to draw a final flow chart for the management of gastric leaks after laparoscopic sleeve gastrectomy, based on the review of our cases over 10 years' experience. Material and Methods. We retrospectively reviewed all patients who underwent LSG as a primary operation at the Bariatric Unit of Tor Vergata University Hospital in Rome from 2007 to 2015. Results. Patients included in the study were 418. There were 6 staple line leaks (1.44%). All patients with diagnosis of a leak were initially discharged home in good clinical conditions and then returned to A&E because of the complication. The mean interval between surgery and readmission for leak was 13,4 days (range 6-34 days, SD ± 11.85). We recorded one death (16.67%) due to sepsis. The remaining five cases were successfully treated with a mean healing time of the gastric leak of 55,5 days (range 26-83 days; SD ± 25.44). Conclusion. Choosing the proper treatment depends on clinical stability and on the presence or not of collected abscess. Our treatment protocol showed being associated with low complication rate and minor discomfort to the patients, reducing the need for more invasive procedures.
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Affiliation(s)
- Mauro Montuori
- Bariatric Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, 00133 Rome, Italy
- *Mauro Montuori:
| | - Domenico Benavoli
- Bariatric Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Stefano D'Ugo
- Bariatric Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Luca Di Benedetto
- Bariatric Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Emanuela Bianciardi
- Psychiatry Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Achille L. Gaspari
- Bariatric Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Paolo Gentileschi
- Bariatric Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, 00133 Rome, Italy
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