Skip to main content
Top
Published in: Obesity Surgery 8/2016

01-08-2016 | Original Contributions

A Specifically Designed Stent for Anastomotic Leaks after Bariatric Surgery: Experiences in a Tertiary Referral Hospital

Authors: Martin R. van Wezenbeek, Martine M. de Milliano, Simon W. Nienhuijs, Pieter Friederich, Lennard P. L. Gilissen

Published in: Obesity Surgery | Issue 8/2016

Login to get access

Abstract

Background

The management of anastomotic leakage after either laparoscopic Roux-en-Y gastric bypass (LGBP) or laparoscopic sleeve gastrectomy (LSG) remains a burden. Various options are available for the treatment of these leaks. A newer and less invasive option for the treatment of leaks is the use of endoluminal stents. The main drawback for this treatment is stent migration. The current study describes the outcome of a new, specifically designed stent for the treatment of anastomotic leaks after bariatric surgery.

Methods

For this retrospective observational study, the medical charts of patients undergoing bariatric surgery between October 1, 2010 and July 1, 2013 were reviewed. All patients with anastomotic leakage, treated with the bariatric Hanarostent, were included.

Results

Twelve patients were included out of a total of 1702 bariatric patients in the described period. Seven had a leakage after LSG, five after LGBP. An average of 2.4 endoscopic procedures and 1.25 stents were used per patient. Successful treatment was seen in nine out of 12 patients (75 %). Most common complication was dislocation or migration of the stent, occurring in eight patients (66.7 %).

Conclusions

The ECBB Hanarostent®, which was specifically designed for post bariatric leakages, shows equal but not favorable success rates in this small series compared to previous reports on other types of stenting techniques. Despite the stent design, the complication rate is not reduced and the main future goal should be to target the high stent migration rate.
Literature
1.
go back to reference Ribaric G, Buchwald JN, McGlennon TW. Diabetes and weight in comparative studies of bariatric surgery vs conventional medical therapy: a systematic review and meta-analysis. Obes Surg. 2014;24(3):437–55.CrossRefPubMed Ribaric G, Buchwald JN, McGlennon TW. Diabetes and weight in comparative studies of bariatric surgery vs conventional medical therapy: a systematic review and meta-analysis. Obes Surg. 2014;24(3):437–55.CrossRefPubMed
2.
go back to reference Sjostrom L. Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study. Int J Obes. 2008;32 Suppl 7:S93–7.CrossRef Sjostrom L. Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study. Int J Obes. 2008;32 Suppl 7:S93–7.CrossRef
3.
go back to reference Sjostrom L, Lindroos AK, 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 Sjostrom L, Lindroos AK, 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
4.
go back to reference Sanni A, Perez S, Medbery R, et al. Postoperative complications in bariatric surgery using age and BMI stratification: a study using ACS-NSQIP data. Surg Endosc. 2014;28(12):3302–9.CrossRefPubMed Sanni A, Perez S, Medbery R, et al. Postoperative complications in bariatric surgery using age and BMI stratification: a study using ACS-NSQIP data. Surg Endosc. 2014;28(12):3302–9.CrossRefPubMed
5.
go back to reference Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26(6):1509–15.CrossRefPubMed Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26(6):1509–15.CrossRefPubMed
6.
go back to reference van Rutte PW, Smulders JF, de Zoete JP, et al. Outcome of sleeve gastrectomy as a primary bariatric procedure. Br J Surg. 2014;101(6):661–8.CrossRefPubMed van Rutte PW, Smulders JF, de Zoete JP, et al. Outcome of sleeve gastrectomy as a primary bariatric procedure. Br J Surg. 2014;101(6):661–8.CrossRefPubMed
7.
go back to reference Weiner RA, El-Sayes IA, Theodoridou S, et al. Early post-operative complications: incidence, management, and impact on length of hospital stay. A retrospective comparison between laparoscopic gastric bypass and sleeve gastrectomy. Obes Surg. 2013;23(12):2004–12.CrossRefPubMed Weiner RA, El-Sayes IA, Theodoridou S, et al. Early post-operative complications: incidence, management, and impact on length of hospital stay. A retrospective comparison between laparoscopic gastric bypass and sleeve gastrectomy. Obes Surg. 2013;23(12):2004–12.CrossRefPubMed
8.
go back to reference Whitlock KA, Gill RS, Ali T, et al. Early outcomes of Roux-en-Y gastric bypass in a publically funded obesity program. ISRN Obes. 2013;2013:296597.PubMedPubMedCentral Whitlock KA, Gill RS, Ali T, et al. Early outcomes of Roux-en-Y gastric bypass in a publically funded obesity program. ISRN Obes. 2013;2013:296597.PubMedPubMedCentral
9.
go back to reference Jacobsen HJ, Nergard BJ, Leifsson BG, et al. Management of suspected anastomotic leak after bariatric laparoscopic Roux-en-y gastric bypass. Br J Surg. 2014;101(4):417–23.CrossRefPubMedPubMedCentral Jacobsen HJ, Nergard BJ, Leifsson BG, et al. Management of suspected anastomotic leak after bariatric laparoscopic Roux-en-y gastric bypass. Br J Surg. 2014;101(4):417–23.CrossRefPubMedPubMedCentral
10.
go back to reference Schiesser M, Kressig P, Bueter M, et al. Successful endoscopic management of gastrointestinal leakages after laparoscopic Roux-en-Y gastric bypass surgery. Dig Surg. 2014;31(1):67–70.CrossRef Schiesser M, Kressig P, Bueter M, et al. Successful endoscopic management of gastrointestinal leakages after laparoscopic Roux-en-Y gastric bypass surgery. Dig Surg. 2014;31(1):67–70.CrossRef
11.
go back to reference 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 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
12.
go back to reference Urschel JD. Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review. Am J Surg. 1995;169(6):634–40.CrossRefPubMed Urschel JD. Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review. Am J Surg. 1995;169(6):634–40.CrossRefPubMed
13.
go back to reference van Boeckel PG, Sijbring A, Vleggaar FP, et al. Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus. Aliment Pharmacol Ther. 2011;33(12):1292–301.CrossRefPubMed van Boeckel PG, Sijbring A, Vleggaar FP, et al. Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus. Aliment Pharmacol Ther. 2011;33(12):1292–301.CrossRefPubMed
14.
go back to reference Salminen P, Gullichsen R, Laine S. Use of self-expandable metal stents for the treatment of esophageal perforations and anastomotic leaks. Surg Endosc. 2009;23(7):1526–30.CrossRefPubMed Salminen P, Gullichsen R, Laine S. Use of self-expandable metal stents for the treatment of esophageal perforations and anastomotic leaks. Surg Endosc. 2009;23(7):1526–30.CrossRefPubMed
15.
go back to reference Puig CA, Waked TM, Baron Sr TH, et al. The role of endoscopic stents in the management of chronic anastomotic and staple line leaks and chronic strictures after bariatric surgery. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2014;10(4):613–7.CrossRef Puig CA, Waked TM, Baron Sr TH, et al. The role of endoscopic stents in the management of chronic anastomotic and staple line leaks and chronic strictures after bariatric surgery. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2014;10(4):613–7.CrossRef
16.
go back to reference Victorzon M, Victorzon S, Peromaa-Haavisto P. Fibrin glue and stents in the treatment of gastrojejunal leaks after laparoscopic gastric bypass: a case series and review of the literature. Obes Surg. 2013;23(10):1692–7.CrossRefPubMed Victorzon M, Victorzon S, Peromaa-Haavisto P. Fibrin glue and stents in the treatment of gastrojejunal leaks after laparoscopic gastric bypass: a case series and review of the literature. Obes Surg. 2013;23(10):1692–7.CrossRefPubMed
17.
go back to reference Donatelli G, Dhumane P, Perretta S, et al. Endoscopic placement of fully covered self expanding metal stents for management of post-operative foregut leaks. J Minim Access Surg. 2012;8(4):118–24.CrossRefPubMedPubMedCentral Donatelli G, Dhumane P, Perretta S, et al. Endoscopic placement of fully covered self expanding metal stents for management of post-operative foregut leaks. J Minim Access Surg. 2012;8(4):118–24.CrossRefPubMedPubMedCentral
18.
go back to reference 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 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
19.
go back to reference Sharaiha RZ, Kim KJ, Singh VK, et al. Endoscopic stenting for benign upper gastrointestinal strictures and leaks. Surg Endosc. 2014;28(1):178–84.CrossRefPubMed Sharaiha RZ, Kim KJ, Singh VK, et al. Endoscopic stenting for benign upper gastrointestinal strictures and leaks. Surg Endosc. 2014;28(1):178–84.CrossRefPubMed
20.
go back to reference Choi HJ, Lee BI, Kim JJ, et al. The temporary placement of covered self-expandable metal stents to seal various gastrointestinal leaks after surgery. Gut Liver. 2013;7(1):112–5.CrossRefPubMedPubMedCentral Choi HJ, Lee BI, Kim JJ, et al. The temporary placement of covered self-expandable metal stents to seal various gastrointestinal leaks after surgery. Gut Liver. 2013;7(1):112–5.CrossRefPubMedPubMedCentral
21.
go back to reference Leenders BJ, Stronkhorst A, Smulders FJ, et al. Removable and repositionable covered metal self-expandable stents for leaks after upper gastrointestinal surgery: experiences in a tertiary referral hospital. Surg Endosc. 2013;27(8):2751–9.CrossRefPubMed Leenders BJ, Stronkhorst A, Smulders FJ, et al. Removable and repositionable covered metal self-expandable stents for leaks after upper gastrointestinal surgery: experiences in a tertiary referral hospital. Surg Endosc. 2013;27(8):2751–9.CrossRefPubMed
22.
go back to reference Coblijn UK, Verveld CJ, van Wagensveld BA, et al. Laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy as revisional procedure after adjustable gastric band—a systematic review. Obes Surg. 2013;23(11):1899–914.CrossRefPubMed Coblijn UK, Verveld CJ, van Wagensveld BA, et al. Laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy as revisional procedure after adjustable gastric band—a systematic review. Obes Surg. 2013;23(11):1899–914.CrossRefPubMed
23.
go back to reference Perathoner A, Zitt M, Lanthaler M, et al. Long-term follow-up evaluation of revisional gastric bypass after failed adjustable gastric banding. Surg Endosc. 2013;27(11):4305–12.CrossRefPubMed Perathoner A, Zitt M, Lanthaler M, et al. Long-term follow-up evaluation of revisional gastric bypass after failed adjustable gastric banding. Surg Endosc. 2013;27(11):4305–12.CrossRefPubMed
24.
go back to reference Zhang L, Tan WH, Chang R, et al. Perioperative risk and complications of revisional bariatric surgery compared to primary Roux-en-Y gastric bypass. Surg Endosc. 2014. Zhang L, Tan WH, Chang R, et al. Perioperative risk and complications of revisional bariatric surgery compared to primary Roux-en-Y gastric bypass. Surg Endosc. 2014.
25.
go back to reference Eisendrath P, Cremer M, Himpens J, et al. Endotherapy including temporary stenting of fistulas of the upper gastrointestinal tract after laparoscopic bariatric surgery. Endoscopy. 2007;39(7):625–30.CrossRefPubMed Eisendrath P, Cremer M, Himpens J, et al. Endotherapy including temporary stenting of fistulas of the upper gastrointestinal tract after laparoscopic bariatric surgery. Endoscopy. 2007;39(7):625–30.CrossRefPubMed
26.
go back to reference 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 8-9.CrossRefPubMed 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 8-9.CrossRefPubMed
27.
go back to reference Puli SR, Spofford IS, Thompson CC. Use of self-expandable stents in the treatment of bariatric surgery leaks: a systematic review and meta-analysis. Gastrointest Endosc. 2012;75(2):287–93.CrossRefPubMed Puli SR, Spofford IS, Thompson CC. Use of self-expandable stents in the treatment of bariatric surgery leaks: a systematic review and meta-analysis. Gastrointest Endosc. 2012;75(2):287–93.CrossRefPubMed
28.
go back to reference Salinas A, Baptista A, Santiago E, et al. Self-expandable metal stents to treat gastric leaks. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2006;2(5):570–2.CrossRef Salinas A, Baptista A, Santiago E, et al. Self-expandable metal stents to treat gastric leaks. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2006;2(5):570–2.CrossRef
29.
go back to reference Oshiro T, Kasama K, Umezawa A, et al. Successful management of refractory staple line leakage at the esophagogastric junction after a sleeve gastrectomy using the HANAROSTENT. Obes Surg. 2010;20(4):530–4.CrossRefPubMed Oshiro T, Kasama K, Umezawa A, et al. Successful management of refractory staple line leakage at the esophagogastric junction after a sleeve gastrectomy using the HANAROSTENT. Obes Surg. 2010;20(4):530–4.CrossRefPubMed
30.
go back to reference Blackmon SH, Santora R, Schwarz P, et al. Utility of removable esophageal covered self-expanding metal stents for leak and fistula management. Ann Thorac Surg. 2010;89(3):931–6. discussion 6-7.CrossRefPubMed Blackmon SH, Santora R, Schwarz P, et al. Utility of removable esophageal covered self-expanding metal stents for leak and fistula management. Ann Thorac Surg. 2010;89(3):931–6. discussion 6-7.CrossRefPubMed
31.
go back to reference Uitdehaag MJ, van Hooft JE, Verschuur EM, et al. A fully-covered stent (Alimaxx-E) for the palliation of malignant dysphagia: a prospective follow-up study. Gastrointest Endosc. 2009;70(6):1082–9.CrossRefPubMed Uitdehaag MJ, van Hooft JE, Verschuur EM, et al. A fully-covered stent (Alimaxx-E) for the palliation of malignant dysphagia: a prospective follow-up study. Gastrointest Endosc. 2009;70(6):1082–9.CrossRefPubMed
Metadata
Title
A Specifically Designed Stent for Anastomotic Leaks after Bariatric Surgery: Experiences in a Tertiary Referral Hospital
Authors
Martin R. van Wezenbeek
Martine M. de Milliano
Simon W. Nienhuijs
Pieter Friederich
Lennard P. L. Gilissen
Publication date
01-08-2016
Publisher
Springer US
Published in
Obesity Surgery / Issue 8/2016
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-015-2027-6

Other articles of this Issue 8/2016

Obesity Surgery 8/2016 Go to the issue