Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 10/2015

01-10-2015 | Original Contributions

Effect of Early Use of Covered Self-Expandable Endoscopic Stent on the Treatment of Postoperative Stapler Line Leaks

Authors: Nicolás Quezada, Cristóbal Maiz, David Daroch, Ricardo Funke, Allan Sharp, Camilo Boza, Fernando Pimentel

Published in: Obesity Surgery | Issue 10/2015

Login to get access

Abstract

Background

Postoperative leaks are a dreaded complication after bariatric surgery (BS). Its treatment is based on nutritional support and sepsis control by antibiotics, collections drainage and/or prosthesis, and/or surgery.

Objectives

The aim of this study is to report our experience with coated self-expandable endoscopic stents (SEES) for leaks treatment.

Setting

This study was performed in a University Hospital, (censored).

Methods

We performed a retrospective analysis of our BS database from January 2007 to December 2013. All patients with leak after BS treated with SEES were included.

Results

We identified 29 patients; 17 (59 %) were women, with median age of 37 (19–65) years, and preoperative body mass index of 40 (28.7–56-6) kg/m2. Nineteen (65.5 %) patients had a sleeve gastrectomy and 10 (34.5 %) a Roux-en-Y gastric bypass. All patients had a leak in the stapler line. Median time from surgery to leak diagnosis was 7 (1–51) days, and SEES were installed 8 (0–104) days after diagnosis. Twenty-one (72 %) patients also had abdominal exploration. Median length of SEES use was 60 (1–299) days. Patients who had SEES as primary treatment (with or without simultaneous reoperation) had a shorter leak closure time (50 [6–112] vs 109 [60–352] days; p = 0.008). Twenty-eight (96.5 %) patients successfully achieved leak closure with SEES. There were 16 migrations in 10 (34 %) patients, 1 (3 %) stent fracture, 1 opening of the blind end of alimentary limb (3 %), and 5 patients (17 %) required a second stent due to leak persistence.

Conclusions

SEES is a feasible, safe, and effective management of post BS leaks, although patients may also require prosthesis revision and abdominal exploration. Primary SEES placement is associated with a shorter leak resolution time.
Literature
1.
Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.CrossRefPubMed
2.
Sjöström L, Lindroos A-K, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.CrossRefPubMed
3.
Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. N Engl J Med. 2014;370(21):2002–13.CrossRefPubMed
4.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.CrossRefPubMed
5.
6.
Lee S, Carmody B, Wolfe L, et al. Effect of location and speed of diagnosis on anastomotic leak outcomes in 3828 gastric bypass cases. J Gastrointest Surg. 2007;11(6):708–13.CrossRefPubMed
7.
Maher JW, Martin Hawver L, Pucci A, et al. Four hundred fifty consecutive laparoscopic Roux-en-Y gastric bypasses with no mortality and declining leak rates and lengths of stay in a bariatric training program. J Am Coll Surg. 2008;206(5):940–4. discussion 944–945.CrossRefPubMed
8.
Sakran N, Goitein D, Raziel A, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2013;27(1):240–5.CrossRefPubMed
9.
De Aretxabala X, Leon J, Wiedmaier G, et al. Gastric leak after sleeve gastrectomy: analysis of its management. Obes Surg. 2011;21(8):1232–7.CrossRefPubMed
10.
Spyropoulos C, Argentou M-I, Petsas T, et al. Management of gastrointestinal leaks after surgery for clinically severe obesity. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2012;8(5):609–15.CrossRef
11.
Yimcharoen P, Heneghan HM, Tariq N, et al. Endoscopic stent management of leaks and anastomotic strictures after foregut surgery. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2011;7(5):628–36.CrossRef
12.
Rajan PS, Bansal S, Balaji NS, et al. Role of endoscopic stents and selective minimal access drainage in oesophageal leaks: feasibility and outcome. Surg Endosc. 2014;28(8):2368–73.CrossRefPubMed
13.
Nguyen NT, Rudersdorf PD, Smith BR, et al. Management of gastrointestinal leaks after minimally invasive esophagectomy: conventional treatments vs. endoscopic stenting. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2011;15(11):1952–60.CrossRef
14.
Sharma P, Kozarek R, Practice Parameters Committee of American College of Gastroenterology. Role of esophageal stents in benign and malignant diseases. Am J Gastroenterol. 2010;105(2):258–73. quiz 274.CrossRefPubMed
15.
Eubanks S, Edwards CA, Fearing NM, et al. Use of endoscopic stents to treat anastomotic complications after bariatric surgery. J Am Coll Surg. 2008;206(5):935–8. discussion 938–939.CrossRefPubMed
16.
Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, et al. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2012;8(1):8–19.CrossRef
17.
Clinical Issues Committee ASMBS. ASMBS guideline on the prevention and detection of gastrointestinal leak after gastric bypass including the role of imaging and surgical exploration. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2009;5(3):293–6.
18.
Simon F, Siciliano I, Gillet A, et al. Gastric leak after laparoscopic sleeve gastrectomy: early covered self-expandable stent reduces healing time. Obes Surg. 2013;23(5):687–92.CrossRefPubMed
19.
Pequignot A, Fuks D, Verhaeghe P, et al. Is there a place for pigtail drains in the management of gastric leaks after laparoscopic sleeve gastrectomy? Obes Surg. 2012;22(5):712–20.CrossRefPubMed
20.
Tan JT, Kariyawasam S, Wijeratne T, et al. Diagnosis and management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg. 2010;20(4):403–9.CrossRefPubMed
21.
Lee SD, Khouzam MN, Kellum JM, et al. Selective, versus routine, upper gastrointestinal series leads to equal morbidity and reduced hospital stay in laparoscopic gastric bypass patients. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2007;3(4):413–6.CrossRef
22.
Csendes A, Braghetto I, León P, et al. Management of leaks after laparoscopic sleeve gastrectomy in patients with obesity. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2010;14(9):1343–8.CrossRef
23.
Gonzalez R, Sarr MG, Smith CD, et al. Diagnosis and contemporary management of anastomotic leaks after gastric bypass for obesity. J Am Coll Surg. 2007;204(1):47–55.CrossRefPubMed
24.
Madan AK, Stoecklein HH, Ternovits CA, et al. Predictive value of upper gastrointestinal studies versus clinical signs for gastrointestinal leaks after laparoscopic gastric bypass. Surg Endosc. 2007;21(2):194–6.CrossRefPubMed
25.
Babor R, Talbot M, Tyndal A. Treatment of upper gastrointestinal leaks with a removable, covered, self-expanding metallic stent. Surg Laparosc Endosc Percutan Tech. 2009;19(1):e1–4.CrossRefPubMed
26.
El Mourad H, Himpens J, Verhofstadt J. Stent treatment for fistula after obesity surgery: results in 47 consecutive patients. Surg Endosc. 2013;27(3):808–16.CrossRefPubMed
27.
Swinnen J, Eisendrath P, Rigaux J, et al. Self-expandable metal stents for the treatment of benign upper GI leaks and perforations. Gastrointest Endosc. 2011;73(5):890–9.CrossRefPubMed
28.
Iqbal A, Miedema B, Ramaswamy A, et al. Long-term outcome after endoscopic stent therapy for complications after bariatric surgery. Surg Endosc. 2011;25(2):515–20.CrossRefPubMed
29.
Sharaiha RZ, Kumta NA, Doukides TP, et al. Esophageal Stenting With Sutures: Time to Redefine our Standards? J Clin Gastroenterol. 2014.
Metadata
Title
Effect of Early Use of Covered Self-Expandable Endoscopic Stent on the Treatment of Postoperative Stapler Line Leaks
Authors
Nicolás Quezada
Cristóbal Maiz
David Daroch
Ricardo Funke
Allan Sharp
Camilo Boza
Fernando Pimentel
Publication date
01-10-2015
Publisher
Springer US
Published in
Obesity Surgery / Issue 10/2015
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-015-1622-x

Other articles of this Issue 10/2015

Obesity Surgery 10/2015 Go to the issue

Original Contributions

Perioperative Outcomes of Proximal and Distal Gastric Bypass in Patients with BMI Ranged 50–60 kg/m2—A Double-Blind, Randomized Controlled Trial

Video Submission

Endoscopic Management of Massive Hemorrhage 12 h Post Laparoscopic Roux-en-Y Gastric Bypass

Review Article

Short- and Long-Term Effects of Abdominal Lipectomy on Weight and Fat Mass in Females: a Systematic Review

Erratum

Erratum to: Impact of Extent of Antral Resection on Surgical Outcomes of Sleeve Gastrectomy for Morbid Obesity (A Prospective Randomized Study)

Original Contributions

Comparison of Rhabdomyolysis Markers in Patients Undergoing Bariatric Surgery with Propofol and Inhalation-based Anesthesia

Letter to the Editor

Positioning Trocars for Performing Sleeve Gastrectomy: the right side or between the legs of the patient?