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01-12-2020 | Endoscopy | Research article

Endoscopic treatment of early leaks and strictures after laparoscopic one anastomosis gastric bypass

Authors: Fadi Younis, Mati Shnell, Nathan Gluck, Subhi Abu-Abeid, Shai Eldar, Sigal Fishman

Published in: BMC Surgery | Issue 1/2020

Abstract

Background

Laparoscopic one anastomosis gastric bypass has become a prominent bariatric procedure. Yet, early and late complications, primarily leaks and strictures, are not uncommon. This study summarizes our experience with endoscopic treatment of laparoscopic one anastomosis gastric bypass complications.

Methods

This is a retrospective study of consecutive patients referred to our hospital from 2015 to 2017 with post laparoscopic one anastomosis gastric bypass complications. Therapy was tailored to each case, including fully covered self-expandable metal stents, fibrin glue, septotomy, internal drainage with pigtail stents, through-the-scope and pneumatic dilation. Success was defined as resuming oral nutrition without enteral or parenteral support or further surgical intervention.

Results

Nine patients presented with acute or early leaks: 5 (56%) had staple-line leaks, 3 (33%) had anastomotic leaks and 1 (11%) had both. All were treated with stents. Adjunctive endoscopic drainage was applied in 4 patients (44%). Overall 5 patients (56%) with acute/ early leaks recovered completely, including all 3 patients with anastomotic leak and the patient with both leaks but only 1/5 with staple line leak (20%). Complication rate in the leak group reached 22%. Eight patients presented with strictures, 7 at the anastomosis and one due to remnant stomach misalignment. All anastomotic strictures were dilated successfully. However, the patient with the pouch stricture required conversion to Roux-en-Y gastric bypass after 3 failed attempts of dilation.

Conclusion

Endoscopic treatments of laparoscopic one anastomosis gastric bypass complications are relatively effective and safe. Anastomosis-related complications are more amenable to endoscopic treatment compared to staple line leaks.

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Title: Endoscopic treatment of early leaks and strictures after laparoscopic one anastomosis gastric bypass
Authors: Fadi Younis
Mati Shnell
Nathan Gluck
Subhi Abu-Abeid
Shai Eldar
Sigal Fishman
Publication date: 01-12-2020
Publisher: BioMed Central
Keyword: Endoscopy
Published in: BMC Surgery / Issue 1/2020
Electronic ISSN: 1471-2482
DOI: https://doi.org/10.1186/s12893-020-0686-2

At a glance: The STEP trials

Springer Medicine

Endoscopic treatment of early leaks and strictures after laparoscopic one anastomosis gastric bypass

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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