Abstract
Purpose
Management of staple line leaks (SLL) after sleeve gastrectomy (SG) is challenging. The aim of this study was to evaluate the effectiveness of a novel endoscopic vacuum therapy (EVT) modality in the management of sleeve leaks.
Materials and Methods
Eight patients were treated with EVT for SLL. Therapy data and outcome measures including duration of therapy, therapy success, and change of treatment strategy were collected and analyzed.
Results
During the study period, SLL occurred in 1.6% of patients who underwent SG. After 9.8 ± 8.6 days of EVT, 3.3 ± 2.2 endoscopies, and 19 ± 15.1 days of hospitalization, endoscopic treatment using EVT was successful in seven out of eight patients (87.5%).
Conclusions
EVT is an effective method for the management of staple line leaks after sleeve gastrectomy. The use of the intraluminal open-pore film drainage (OFD) could be considered as an advantageous modality of EVT, regarding placement and complications.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Gagner M, Buchwald JN. Comparison of laparoscopic sleeve gastrectomy leak rates in four staple-line reinforcement options: a systematic review. Surg Obes Relat Dis. 2014;10(4):713–23.
Noel P, Nedelcu M, Gagner M. Impact of the surgical experience on leak rate after laparoscopic sleeve gastrectomy. Obes Surg. 2016;26(8):1782–7.
Leeds SG, Burdick JS. Management of gastric leaks after sleeve gastrectomy with endoluminal vacuum (E-Vac) therapy. Surg Obes Relat Dis. 2016;12(7):1278–85.
Liu SY, Wong SK, Ng EK. Novel oesophago-gastro-duodenal stenting for gastric leaks after laparoscopic sleeve gastrectomy. Obes Res Clin Pract. 2015;9(3):214–9.
Loske G, Schorsch T, Muller C. Intraluminal and intracavitary vacuum therapy for esophageal leakage: a new endoscopic minimally invasive approach. Endoscopy. 2011;43(6):540–4.
Smallwood NR, Fleshman JW, Leeds SG, et al. The use of endoluminal vacuum (E-Vac) therapy in the management of upper gastrointestinal leaks and perforations. Surg Endosc. 2016;30(6):2473–80.
Loske G, Schorsch T, van Ackeren V, Schulze W, Muller CT. Endoscopic vacuum therapy in Boerhaave's syndrome with open-pore polyurethane foam and a new open-pore film drainage. Endoscopy. 2015;47 Suppl 1 UCTN:E410-1.
Kuehn F, Loske G, Schiffmann L, et al. Endoscopic vacuum therapy for various defects of the upper gastrointestinal tract. Surg Endosc. 2017;31(9):3449–58.
Loske G, Rucktaschel F, Schorsch T, et al. Successful endoscopic vacuum therapy with new open-pore film drainage in a case of iatrogenic duodenal perforation during ERCP. Endoscopy. 2015;47(S 01):E577–E8.
Loske G, Schorsch T, Gobrecht O, et al. Transgastric endoscopic vacuum therapy with a new open-pore film drainage device in a case of infective pancreatic necrosis. Endoscopy. 2016;48(Suppl 1):E148–9.
Loske G, Schorsch T, Kiesow RU, et al. First report of urinary endoscopic vacuum therapy: for large bladder defect after abdomino-perineal excision of the rectum. Video Paper Chirurg. 2017;88(Suppl 1):42–7.
Loske G, Lang U, Schorsch T, et al. Complex vacuum therapy of an abdominal abscess from gastric perforation: case report of innovative operative endoscopic management. Chirurg. 2015;86(5):486–90.
Schmidt F, Mennigen R, Vowinkel T, et al. Endoscopic vacuum therapy (EVT)-a new concept for complication management in bariatric surgery. Obes Surg. 2017;27(9):2499–505.
Dammaro C, Lainas P, Dumont JL, et al. Endoscopic internal drainage coupled to prompt external drainage mobilization is an effective approach for the treatment of complicated cases of sleeve gastrectomy. Obes Surg. 2019;29(9):2929–35.
Willy C, von Thun-Hohenstein H, von Lubken F, et al. Experimental principles of the V.A.C.-therapy - pressure values in superficial soft tissue and the applied foam. Zentralbl Chir. 2006;131(Suppl 1):S50–61.
Laukoetter MG, Mennigen R, Neumann PA, et al. Successful closure of defects in the upper gastrointestinal tract by endoscopic vacuum therapy (EVT): a prospective cohort study. Surg Endosc. 2017;31(6):2687–96.
Mion F, Tolone S, Garros A, et al. High-resolution impedance manometry after sleeve gastrectomy: increased intragastric pressure and reflux are frequent events. Obes Surg. 2016;26(10):2449–56.
Baker RS, Foote J, Kemmeter P, et al. The science of stapling and leaks. Obes Surg. 2004;14(10):1290–8.
Lee JH, Kim CG, Kim YW, et al. Botulinum toxin injection for the treatment of delayed gastric emptying following pylorus-preserving gastrectomy: an initial experience. J Gastric Cancer. 2017;17(2):173–9.
Fuchs HF, Broderick RC, Harnsberger CR, et al. Intraoperative endoscopic Botox injection during total esophagectomy prevents the need for pyloromyotomy or dilatation. J Laparoendosc Adv Surg Tech A. 2016;26(6):433–8.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest
Ethical Approval
The local ethic committee at the University Hospital of Tübingen, Germany, approved this study.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Archid, R., Wichmann, D., Klingert, W. et al. Endoscopic Vacuum Therapy for Staple Line Leaks after Sleeve Gastrectomy. OBES SURG 30, 1310–1315 (2020). https://doi.org/10.1007/s11695-019-04269-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-019-04269-6