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Endoscopic vacuum therapy (EVT) for early infradiaphragmal leakage after bariatric surgery—outcomes of six consecutive cases in a single institution

  • Bernhard Morell
  • Fritz Murray
  • Diana Vetter
  • Marco Bueter
  • Christoph GublerEmail author
How-I-Do-It article
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Abstract

Purpose

Anastomotic leakages or staple line defects after Roux-en-Y gastric bypass (RYGB) and primary laparoscopic sleeve gastrectomy (LSG), respectively, with consecutive bariatric revisional surgery are associated with relevant morbidity and mortality rates. Endoscopic vacuum therapy (EVT) with or without stent-over-sponge (SOS) has been shown to be a promising therapy in foregut wall defects of various etiologies and may therefore be applied in the treatment of postbariatric leaks.

Methods

We report the results of six consecutive patients treated with EVT (83% in combination with SOS) for early postoperative leakages in close proximity to the esophagogastric junction (EGJ) after LSG (n = 2) and RYGB (n = 4) from May 2016 to May2018.

Results

All patients (2/6 male, median age 51 years, median BMI 44.2 kg/m2) were treated successfully without further signs of persisting leakage at the last gastroscopy. The lesions’ size ranged from 0.5 cm2 to 9 cm2, and the leaks were connected to large (max. 225 cm2) abscess cavities in 80% of the cases. Median duration of treatment (= EVT in situ) was 23.5 days (range, 7–89). The number of endoscopic interventions ranged from 1 to 24 (median, n = 7), with a median duration between vacuum sponge replacements of 4 days.

Conclusion

EVT is an effective and safe treatment for staple line defects or anastomotic leakage after bariatric surgeries and can therefore be adopted for the treatment of midgut wall defects. Further studies with a greater number of patients comparing surgical drainage alone or in combination with EVT versus EVT alone are needed.

Keywords

Endoscopic vacuum therapy Stent-over-sponge Laparoscopic sleeve gastrectomy Roux-en-Y gastric bypass Anastomotic leakage SEMS 

Abbreviations

LSG

Laparoscopic sleeve gastrectomy

RYGB

Roux-en-Y gastric bypass

GI

Gastrointestinal

SEMS

Self-expandable metal stent

EVT

Endoscopic vacuum therapy

SOS

Stent-over-sponge

EGJ

Esophagogastric junction

CT

Computed tomography

Notes

Authors’ contributions

Study concept and design: Bernhard Morell, Fritz Murray, Christoph Gubler. Acquisition of data: Bernhard Morell, Fritz Murray, Marco Bueter. Analysis and interpretation of data: Bernhard Morell, Fritz Murray, Christoph Gubler. Drafting of manuscript: Bernhard Morell, Fritz Murray. Critical revision of manuscript: Marco Bueter, Diana Vetter.

Compliance with ethical standards

We (the authors) have nothing to disclose. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Gastroenterology and HepatologyUniversity Hospital ZurichZurichSwitzerland
  2. 2.Division of Surgery and TransplantationUniversity Hospital ZurichZurichSwitzerland

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