Skip to main content
SpringerLink
Log in

Management of Leaks with Endoluminal Stents

  • Chapter
  • First Online:
Endoscopy in Obesity Management

Abstract

Leaks following bariatric surgery occur in 1.6–4.8% of Roux-en-Y gastric bypass (RYGB) procedures and in 1.7–2.4% of laparoscopic sleeve gastrectomy (LSG) cases. Surgical re-exploration for bariatric leaks carries an increased morbidity (15–50%) and mortality (2–10%). Endoscopically placed self-expandable stents offer a noninvasive means of managing bariatric leaks. This chapter focuses on the indications, deployment techniques, and complications of placing endoluminal stents for the treatment of leak following bariatric surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291(10):1238–45.

    Article  PubMed  Google Scholar 

  2. Sjöström L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al, Swedish Obese Subjects Study Scientific Group. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.

    Google Scholar 

  3. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–36.

    Article  PubMed  Google Scholar 

  4. Alaedeen D, Madan AK, Ro CY, Khan KA, Martinez JM, Tichansky DS. Intraoperative endoscopy and leaks after laparoscopic roux-en-Y gastric bypass. Am Surg. 2009;75(6):485–8; discussion 488.

    PubMed  Google Scholar 

  5. 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.

    Article  PubMed  Google Scholar 

  6. Whitlock KA, Gill RS, Ali T, Shi X, Birch DW, Karmali S. Early outcomes of roux-en-Y gastric bypass in a publically funded obesity program. ISRN Obes. 2013;2013:296597.

    PubMed  PubMed Central  Google Scholar 

  7. van Rutte PW, Smulders JF, de Zoete JP, Nienhuijs SW. Outcome of sleeve gastrectomy as a primary bariatric procedure. Br J Surg. 2014;101(6):661–8.

    Article  PubMed  Google Scholar 

  8. Weiner RA, El-Sayes IA, Theodoridou S, Weiner SR, Scheffel O. 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.

    Article  PubMed  Google Scholar 

  9. Andrade JE, Martinez JM. Management of postsurgical leaks and fistulae. In: Thompson C, Ryan MB, editors. Bariatric endoscopy. New York: Springer; 2013. p. 91–101.

    Chapter  Google Scholar 

  10. Gonzalez R, Sarr MG, Smith CD, Baghai M, Kendrick M, Szomstein S, et al. Diagnosis and contemporary management of anastomotic leaks after gastric bypass for obesity. J Am Coll Surg. 2007;204(1):47–55.

    Article  PubMed  Google Scholar 

  11. Madan AK, Lanier B, Tichansky DS. Laparoscopic repair of gastrointestinal leaks after laparoscopic gastric bypass. Am Surg. 2006;72(7):586–90.

    PubMed  Google Scholar 

  12. Walsh C, Karmali S. Endoscopic management of bariatric complications: a review and update. World J Gastrointest Endosc. 2015;7(5):518–23.

    PubMed  PubMed Central  Google Scholar 

  13. Parikh M, Issa R, McCrillis A, Saunders JK, Ude-Welcome A, Gagner M. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg. 2013;257(2):231–7.

    Article  PubMed  Google Scholar 

  14. Sakran N, Goitein D, Raziel A, Keidar A, Beglaibter N, Grinbaum R, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2013;27(1):240–5.

    Article  PubMed  Google Scholar 

  15. Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, Arvidsson D, Baker RS, Basso N, et al. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8(1):8–19.

    Article  PubMed  Google Scholar 

  16. Prathanvanich P, Chand B. Laparoscopic sleeve gatrectomy: management of complications. In: Brethauer SA, Schauer PR, Schirmer BD, editors. Minimally invasive bariatric surgery. New York: Springer; 2015. p. 151–71.

    Google Scholar 

  17. Nimeri A, Ibrahim M, Maasher A, Al HM. Management algorithm for leaks following laparoscopic sleeve gastrectomy. Obes Surg. 2016;26(1):21–5.

    Article  CAS  PubMed  Google Scholar 

  18. Kim J, Azagury D, Eisenberg D, DeMaria E, Campos GM. ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management. Surg Obes Relat Dis. 2015;11(4):739–48.

    Article  PubMed  Google Scholar 

  19. Deitel M, Gagner M, Erickson AL, Crosby RD. Third international summit: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2011;7(6):749–59.

    Article  PubMed  Google Scholar 

  20. Yehoshua RT, Eidelman LA, Stein M, Fichman S, Mazor A, Chen J, et al. Laparoscopic sleeve gastrectomy—volume and pressure assessment. Obes Surg. 2008;18(9):1083–8.

    Article  PubMed  Google Scholar 

  21. Márquez MF, Ayza MF, Lozano RB, Morales Mdel M, Díez JM, Poujoulet RB. Gastric leak after laparoscopic sleeve gastrectomy. Obes Surg. 2010;20(9):1306–11.

    Article  PubMed  Google Scholar 

  22. Jurowich C, Thalheimer A, Seyfried F, Fein M, Bender G, Germer CT, Wichelmann C. Gastric leakage after sleeve gastrectomyclinical presentation and therapeutic options. Langenbeck's Arch Surg. 2011;396(7):981–7.

    Article  Google Scholar 

  23. de Aretxabala X, Leon J, Wiedmaier G, Turu I, Ovalle C, Maluenda F, et al. Gastric leak after sleeve gastrectomy: analysis of its management. Obes Surg. 2011;21(8):1232–7.

    Article  PubMed  Google Scholar 

  24. Martin-Malagon A, Rodriguez-Ballester L, Arteaga-Gonzalez I. Total gastrectomy for failed treatment with endotherapy of chronic gastrocutaneous fistula after sleeve gastrectomy. Surg Obes Relat Dis. 2011;7(2):240–2.

    Article  PubMed  Google Scholar 

  25. El-Ghazaly T, Prathanvanich P, Chand B. Endoscopic stent placement and suturing: management of gastrointestinal anastomotic leaks. In: Kroh M, Reavis KM, editors. The SAGES manual operating through the endoscope. New York: Springer; 2016. p. 127–50.

    Chapter  Google Scholar 

  26. Hamilton EC, Sims TL, Hamilton TT, et al. Clinical predictors of leak after laparoscopic roux-en-Y gastric bypass for morbid obesity. Surg Endosc. 2003;17(5):679–84.

    Article  CAS  PubMed  Google Scholar 

  27. O’Brien PE, MacDonald L, Anderson M, Brennan L, Brown WA. Long-term outcomes after bariatric surgery: fifteen-year follow-up of adjustable gastric banding and a systematic review of the bariatric surgical literature. Ann Surg. 2013;257(1):87–94.

    Article  PubMed  Google Scholar 

  28. Lo Menzo E, Szomstein S, Rosenthal RJ. Laparoscopic gastric bypass: management of complications. In: Brethauer SA, Schauer PR, Schirmer BD, editors. Minimally invasive bariatric surgery. 2nd ed. New York: Springer; 2015. p. 261–9.

    Google Scholar 

  29. Afaneh C, Dakin GF. Enteric leaks after gastric bypass: prevention and management. In: Herron DM, editor. Bariatric surgery complications and emergencies. Cham: Springer International; 2016. p. 81–90.

    Chapter  Google Scholar 

  30. Csendes A, Burgos AM, Braghetto I. Classification and management of leaks after gastric bypass for patients with morbid obesity: a prospective study of 60 patients. Obes Surg. 2012;22(6):855–62.

    Article  PubMed  Google Scholar 

  31. Bingham J, Shawhan R, Parker R, Wigboldy J, Sohn V. Computed tomography scan versus upper gastrointestinal fluoroscopy for diagnosis of staple line leak following bariatric surgery. Am J Surg. 2015;209(5):810–4. discussion 814

    Article  PubMed  Google Scholar 

  32. Symonds CJ. The treatment of malignant stricture of the oesophagus by tubage or permanent catheterism. Br Med J. 1887;1(1373):870–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Irani S, Kozarek RA. History of GI stenting: rigid prostheses in the esophagus. In: Kozarek R, Baron T, Song HY, editors. Self-expandable stents in the gastroinstestinal tract. New York: Springer; 2013. p. 3–13.

    Chapter  Google Scholar 

  34. Frimberger E. Expanding spiral – a new type of prosthesis for the palliative treatment of malignant esophageal stenoses. Endoscopy. 1983;15(S 1):213–4.

    Article  PubMed  Google Scholar 

  35. Knyrim K, Wagner HJ, Bethge N, Keymling M, Vakil N. A controlled trial of an expansile metal stent for palliation of esophageal obstruction due to inoperable cancer. N Engl J Med. 1993;329(18):1302–7.

    Article  CAS  PubMed  Google Scholar 

  36. Domschke W, Foerster EC, Matek W, Rödl W. Self expanding mesh stent for esophageal cancer stenosis. Endoscopy. 1990;22(03):134–6.

    Article  CAS  PubMed  Google Scholar 

  37. Song HY, Choi KC, Cho BH, Ahn DS, Kim KS. Esophagogastric neoplasms: palliation with a modified gianturco stent. Radiology. 1991;180(2):349–54.

    Article  CAS  PubMed  Google Scholar 

  38. Song HY, Park SI, Jung HY, Kim SB, Kim JH, Huh SJ, et al. Benign and malignant esophageal strictures: treatment with a polyurethane-covered retrievable expandable metallic stent. Radiology. 1997;203(3):747–52.

    Article  CAS  PubMed  Google Scholar 

  39. Shimizu H, Annaberdyev S, Motamarry I, Kroh M, Schauer PR, Brethauer SA. Revisional bariatric surgery for unsuccessful weight loss and complications. Obes Surg. 2013;23(11):1766–73.

    Article  PubMed  Google Scholar 

  40. Khaitan L, Van Sickle K, Gonzalez R, Lin E, Ramshaw B, Smith CD. Laparoscopic revision of bariatric procedures: is it feasible? Surg Endosc. 2005;19(6):822–5.

    Article  Google Scholar 

  41. Aryaie AH, Singer JL, Fayezizadeh M, Lash J, Marks JM. Efficacy of endoscopic management of leak after foregut surgery with endoscopic covered self-expanding metal stents (SEMS). Surg Endosc. 2017;31(2):612–7.

    Article  PubMed  Google Scholar 

  42. Sethi M, Parikh M. Enteric leaks after sleeve gastrectomy: prevention and management. In: Herronr DM, editor. Bariatric surgery complications emergencies. Cham: Springer International; 2016. p. 91–105.

    Chapter  Google Scholar 

  43. 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.

    Article  PubMed  Google Scholar 

  44. Laasch H. Current designs of self-expanding stents. In: Kozarek R, Baron T, Song H, editors. Self-expandable stents in the gastrointestinal tract. New York: Springer; 2013. p. 51–69.

    Chapter  Google Scholar 

  45. Kauffman GB, Mayo I. The story of Nitinol: the serendipitous discovery of the memory metal and its applications. Chem Educ. 1996;2(2):1–12.

    Article  Google Scholar 

  46. Eisendrath P, Cremer M, Himpens J, Cadière GB, Le Moine O, Devière J. Endotherapy including temporary stenting of fistulas of the upper gastrointestinal tract after laparoscopic bariatric surgery. Endoscopy. 2007;39(07):625–30.

    Article  CAS  PubMed  Google Scholar 

  47. Efthimiou E, Stein L, Szego P, Court O, Christou N. Stent migration causing alimentary limb obstruction necessitating laparotomy and surgical stent extraction. Surg Obes Relat Dis. 2009;5(3):375–7.

    Article  PubMed  Google Scholar 

  48. van Boeckel PG, Sijbring A, Vleggaar FP, Siersema PD. Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus. Aliment Pharmacol Ther. 2011;33(12):1292–301.

    Article  PubMed  Google Scholar 

  49. Ross AS, Kozarek RA. Esophageal stents: indications and placement techniques. In: Kozarek R, Baron T, Song HY, editors. Self-expandable stents in the gastroinstestinal tract. New York: Springer; 2013. p. 129–40.

    Chapter  Google Scholar 

  50. Wilcox VT, Huang AY, Tariq N, Dunkin BJ. Endoscopic suture fixation of self-expanding metallic stents with and without submucosal injection. Surg Endosc. 2015;29(1):24–9.

    Google Scholar 

  51. Salinas A, Baptista A, Santiago E, Antor M, Salinas H. Self-expandable metal stents to treat gastric leaks. Surg Obes Relat Dis. 2006;2(5):570–2.

    Article  PubMed  Google Scholar 

  52. Freedman J, Jonas E, Näslund E, Nilsson H, Marsk R, Stockeld D. Treatment of leaking gastrojejunostomy after gastric bypass surgery with special emphasis on stenting. Surg Obes Relat Dis. 2013;9(4):554–8.

    Article  PubMed  Google Scholar 

  53. Southwell T, Lim TH, Ogra R. Endoscopic therapy for treatment of staple line leaks post-laparoscopic sleeve gastrectomy (LSG): experience from a large bariatric surgery centre in New Zealand. Obes Surg. 2016;26(6):1155–62.

    Article  PubMed  Google Scholar 

  54. 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.

    Article  PubMed  Google Scholar 

  55. Murino A, Arvanitakis M, Le Moine O, Blero D, Devière J, Eisendrath P. Effectiveness of endoscopic management using self-expandable metal stents in a large cohort of patients with post-bariatric leaks. Obes Surg. 2015;25(9):1569–76.

    Article  PubMed  Google Scholar 

  56. Ko HK, Song HY, Shin JH, Lee GH, Jung HY, Park SI. Fate of migrated esophageal and gastroduodenal stents: experience in 70 patients. J Vasc Interv Radiol. 2007;18(6):725–32.

    Article  PubMed  Google Scholar 

  57. Eubanks S, Edwards CA, Fearing NM, Ramaswamy A, de la Torre RA, Thaler KJ, et al. Use of endoscopic stents to treat anastomotic complications after bariatric surgery. J Am Coll Surg. 2008;206(5):935–8. discussion 938–9

    Article  PubMed  Google Scholar 

  58. Aiolfi A, Bona D, Ceriani C, Porro M, Bonavina L. Stent-in-stent, a safe and effective technique to remove fully embedded esophageal metal stents: case series and literature review. Endosc Int Open. 2015;3(4):E296–9.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Siersema PD, Hirdes MM. What is the optimal duration of stent placement for refractory, benign esophageal strictures? Nat Clin Pract Gastroenterol Hepatol. 2009;6(3):146–7.

    Article  PubMed  Google Scholar 

  60. Vasilikostas G, Sanmugalingam N, Khan O, Reddy M, Groves C, Wan A. ‘stent in a stent’–an alternative technique for removing partially covered stents following sleeve gastrectomy complications. Obes Surg. 2014;24(3):430–2.

    Article  PubMed  Google Scholar 

  61. Alazmi W, Al-Sabah S, Ali DA, Almazeedi S. Treating sleeve gastrectomy leak with endoscopic stenting: the Kuwaiti experience and review of recent literature. Surg Endosc. 2014;28(12):3425–8.

    Article  PubMed  Google Scholar 

  62. Garofalo F, Noreau-Nguyen M, Denis R, Atlas H, Garneau P, Pescarus R. Evolution of endoscopic treatment of sleeve gastrectomy leaks: from partially covered to long, fully covered stents. Surg Obes Relat Dis. 2016;13:925. doi:10.1016/j.soard.2016.12.019. [Epub ahead of print].

    Article  PubMed  Google Scholar 

  63. Moon RC, Shah N, Teixeira AF, Jawad MA. Management of staple line leaks following sleeve gastrectomy. Surg Obes Relat Dis. 2015;11(1):54–9.

    Article  PubMed  Google Scholar 

  64. Edwards CA, Bui TP, Astudillo JA, de la Torre RA, Miedema BW, Ramaswamy A, et al. Management of anastomotic leaks after roux-en-Y bypass using self-expanding polyester stents. Surg Obes Relat Dis. 2008;4(5):594–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Health Sciences Center T18-040, Stony Brook School of Medicine, Stony Brook, NY, 11794-8191, USA

    Salvatore Docimo Jr. D.O., M.Sc & Aurora D. Pryor M.D.

Authors
  1. Salvatore Docimo Jr. D.O., M.Sc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aurora D. Pryor M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Salvatore Docimo Jr. D.O., M.Sc .

Editor information

Editors and Affiliations

  1. Gastrointestinal/Minimally Invasive Surgery, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, USA

    Bipan Chand

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Docimo, S., Pryor, A.D. (2018). Management of Leaks with Endoluminal Stents. In: Chand, B. (eds) Endoscopy in Obesity Management. Springer, Cham. https://doi.org/10.1007/978-3-319-63528-6_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-63528-6_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-63527-9

  • Online ISBN: 978-3-319-63528-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation