, Volume 17, Issue 3, pp 606-608
Date: 23 Oct 2012

The Use of Over the Scope Clip (OTSC) Device for Sleeve Gastrectomy Leak

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Sleeve gastrectomy is increasing in popularity for the treatment of morbid obesity. The most significant complication posed is leak from the resection line. Typically, this occurs at the proximal end of the sleeve, adjacent the gastroesophageal junction. Such leaks can be notoriously persistent resulting in a chronic gastric fistula. Even when low in output, these fistulas rarely spontaneously resolve. It may mean months of poor health, multiple interventions and prolonged hospitalisation.

Various strategies have been employed to aid closure of a sleeve leak, including “drain and wait”, stenting, biological glues, mesh plugs and mucosal clips, all with variable and unreliable success. Many cases ultimately come to complex revisional surgery employing resection or diversion as a solution, but sometimes yielding a less than ideal bariatric result.

A simple endoscopic solution would be ideal to this difficult problem and potentially shift the paradigm of leak management. We report two conse