La radiologia medica

, Volume 118, Issue 6, pp 962–970 | Cite as

Minimally invasive treatment of gastric leak after sleeve gastrectomy

  • Mario Corona
  • Chiara Zini
  • Massimiliano Allegritti
  • Emanuele Boatta
  • Pierleone Lucatelli
  • Alessandro Cannavale
  • Andrea Wlderk
  • Carlo Cirelli
  • Fausto Fiocca
  • Filippo Maria Salvatori
  • Fabrizio Fanelli
Vascular and Interventional Radiology / Radiologia Vascolare e Interventistica

Abstract

Purpose

Obesity is a leading problem in Western countries, and laparoscopic sleeve gastrectomy (SG) is the most commonly used procedure for the surgical management of morbid obesity. SG is recognised as one of the safest and most effective bariatric procedures but it is limited by a rate of gastric leaks (GL) ranging from 1.4% to 20%. No international consensus exists about the treatment of GL. This paper reports our experience with the noninvasive management of GL.

Materials and methods

From July 2004 to December 2010, 16 patients with GL after SG were referred to our unit. All patients underwent contrast radiography (Gastrografin) and computed tomography (CT) examination. On the basis of the radiographic findings, patients were divided into those eligible for drainage and those not eligible.

Results

Twelve patients (75%) were eligible for percutaneous drainage. Of these, seven patients (44%) were successfully treated with percutaneous drainage alone, whereas five patients (31%) required placement of a covered stent due to incomplete resolution of the collection. After 1009.8±456.7 days of follow-up, one patient died from a cardiovascular event and two patients required a bilio-pancreatic-digestive bypass (BPD-BP). Twelve patients (75%) were in an excellent state of health with significant reduction of their body mass index (BMI).

Conclusions

Our experience confirms the value of an algorithm based on patient eligibility for percutaneous drainage in the treatment of GL. The patient’s general condition and in particular the presence of sepsis supports the value of this approach in preference to the conventional surgical approach.

Keywords

Gastric leak Sleeve gastrectomy Percutaneous drainage Stent graft Non-surgical management 

Trattamento minimamente invasivo delle fistole gastriche dopo sleeve gastrectomy

Riassunto

Obiettivo

L’obesità è uno dei problemi emergenti dei paesi industrializzati e la sleeve gastrectomy (SG) è una dei presidi più utilizzati per la cura dell’obesità patologica. La SG è riconosciuta come una delle più sicure tecniche chirurgiche bariatriche, ma è gravata in percentuale variabile dall’1,4% al 20% da fistola gastrica (GL). Non esiste un consensus internazionale sul trattamento del GL dopo SG. Riportiamo la nostra esperienza nel trattamento minimamente invasivo del GL dopo SG.

Materiali e metodi

Da giugno 2004 a gennaio 2010, 16 pazienti con GL post SL sono stati trattati dal nostro team. Tutti i pazienti sono stati sottoposti a transito con mezzo di contrasto per os (Gastrografin) e tomografia computerizzata (CT). In base all’aspetto radiografico i pazienti sono stati suddivisi in passibili di drenaggio e non passibili di drenaggio.

Risultati

Dodici pazienti (75%) sono stati passibili di drenaggio. Di questi in 7 (44%) pazienti il drenaggio percutaneo è stato l’unico presidio terapeutico; 5 pazienti (31%) hanno richiesto stents per la mancata risoluzione del GL. Dopo 1009,8±456,7 giorni di follow-up: 1 paziente è morto per evento cardiovascolare e 2 pazienti sono stati sottoposti a bypass bilio-pancreatico-digestivo. 12 pazienti (75%) presentano un ottimo stato di salute con riduzione dell’indice di massa corporea (BMI).

Conclusioni

La nostra esperienza conferma l’utilizzo di un algoritmo basato sulla fattibilità del drenaggio percutaneo per la cura del GL. La presenza di sepsi corrobora questo approccio rispetto al tradizionale trattamento chirurgico.

Parole chiave

Fistola gastrica Sleeve gastrectomy Drenaggio percutaneo Stent ricoperto Trattamento non chirurgico 

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Copyright information

© Springer-Verlag Italia 2013

Authors and Affiliations

  • Mario Corona
    • 1
  • Chiara Zini
    • 1
  • Massimiliano Allegritti
    • 1
  • Emanuele Boatta
    • 1
  • Pierleone Lucatelli
    • 1
  • Alessandro Cannavale
    • 1
  • Andrea Wlderk
    • 1
  • Carlo Cirelli
    • 1
  • Fausto Fiocca
    • 1
  • Filippo Maria Salvatori
    • 1
  • Fabrizio Fanelli
    • 1
  1. 1.Vascular and Interventional Radiology Unit, Radiology, Oncology and Pathology Department“Sapienza” University of RomeRomeItaly

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