Stent treatment for fistula after obesity surgery: results in 47 consecutive patients
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Leaks occurring after weight loss operations constitute a therapeutic challenge. There is no consensus as to what comprises state-of-the-art management of leaks after bariatric surgery. We sought to determine the efficacy and possible adverse effects of endoluminal stenting for leaks after bariatric surgery.
We report our experience with the stent treatment of consecutive bariatric patients with a leak (retrospective cohort study). Between October 2005 and July 2010, 47 patients presented an acute leak after a bariatric procedure (61 % primary procedures, 39 % revisions). Fifteen patients were initially approached laparoscopically, and 32 were treated by nonoperative techniques. After adequate drainage and resuscitation, all 47 patients were treated by the endoscopic placement of a partially covered metallic stent, and later of a plastic stent inside the metallic prosthesis to facilitate removal. Both stents were then ablated 1 week later. Primary outcome measurement concerned healing of the fistula, as evidenced by radiographic imaging. Secondary outcomes were length of hospital stay and occurrence of peri- and postprocedural complications.
There was no mortality. 41 patients (87.23 %) healed with stent treatment alone; 5 of the 6 persisting leaks healed with laparoscopic intervention (intention-to-treat success rate 96 %). Complication rate was 28.7 %. Length of hospital stay was mean ± standard deviation 22.4 ± 19.38 days for the patients treated by stent alone, and 23.4 ± 18.4 days for the patients requiring additional surgery (P = NS). One patient developed a stricture and required endoscopic dilation, and one is still awaiting surgical treatment.
Leaks after bariatric surgery can be treated safely and effectively by endoscopic stents. In cases of persisting leaks, laparoscopic intervention is successful in a majority of cases. Late strictures seldom occur.
KeywordsLaparoscopic obesity surgery Leaks Stent treatment
Drs. Haicam El Mourad and Johan Verhofstadt have no conflicts of interest or financial ties to disclose. Dr. J Himpens is a consultant with Ethicon Endosurgery and gives talks and organizes workshops for Gore, but there is no conflict of interest with the material presented in this article.
- 10.Papavramidis ST, Eleftheriadis EE, Papavramidis TS, Kotzampassi KE, Gamvros OG (2004) Endoscopic management of gastrocutaneous fistula after bariatric surgery by using a fibrin sealant. Gastrointest Endosc 23(12):1802–1805Google Scholar
- 20.Menenakos E, Stamou KM, Albanopoulos K, Papailiou J, Theodorou D, Leandros E (2010) Laparoscopic sleeve gastrectomy performed with intent to treat morbid obesity: a prospective single-center study of 261 patients with a median follow-up of 1 year. Obes Surg 20(23):276–282PubMedCrossRefGoogle Scholar
- 21.Sánchez-Santos R, Masdevall C, Baltasar A, Martínez-Blázquez C, Ruiz García, de Gordejuela A, Ponsi E, Sánchez-Pernaute A, Vesperinas G, Del Castillo D, Bombuy E, Durán-Escribano C, Ortega L, Ruiz de Adana JC, Baltar J, Maruri I, García-Blázquez E, Torres A (2009) Short- and mid-term outcomes of sleeve gastrectomy for morbid obesity: the experience of the Spanish National Registry. Obes Surg 19(9):1203–1210PubMedCrossRefGoogle Scholar
- 28.Siddiqui AA, Ansari S, Ghouri MA, Memon MS (2010) Self expandable metallic stent endoscopic insertion in esophageal cancer. J Coll Physicians Surg Park 20(8):502–505Google Scholar
- 30.Robson PC, Heffernan N, Gonen M, Thornton R, Brody LA, Holmes R, Brown KT, Covey AM, Fleischer D, Getrajdman GI, Jarnagin W, Sofocleous C, Blumgart L, D Angelica M (2010) Prospective study of outcomes after percutaneous biliary drainage for malignant biliary obstruction. Ann Surg Oncol 17(19):2303–2311PubMedCrossRefGoogle Scholar
- 32.Park do H, Kim MH, Moon SH, Lee SS, Seo DW, Lee SK (2008) Feasibility and safety of placement of a newly designed, fully covered self-expandable metal stent for refractory benign pancreatic ductal strictures: a pilot study [with video]. Gastrointest Endosc 68(6):1182–1189PubMedCrossRefGoogle Scholar