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Obesity Surgery

, Volume 26, Issue 6, pp 1155–1162 | Cite as

Endoscopic Therapy for Treatment of Staple Line Leaks Post-Laparoscopic Sleeve Gastrectomy (LSG): Experience from a Large Bariatric Surgery Centre in New Zealand

  • Thomas Southwell
  • Tien Huey Lim
  • Ravinder Ogra
Original Contributions

Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed bariatric procedures for treatment of morbid obesity. Despite its popularity, it is not without risks, the most serious of which is the staple line leak. Staple line leaks are difficult to manage and require significant resources in the form of surgical, radiological and endoscopic interventions; long hospital and intensive care stay and significant morbidity. International experience is slowly emerging, but there are still no clear guidelines regarding optimal management of leaks. This study aims to describe the experience of endoscopic management of these leaks by the authors and the development of a customised stent for this condition.

Methods

Middlemore Hospital is the largest bariatric surgery centre in New Zealand. Since June 2007, a total of 21 patients have received endotherapy for post-LSG leak management. Treatment included the deployment of primary self-expanding metal stents (SEMS) across the leak site, combined with complementary endoscopic modalities. Persistent leaks were treated with follow-up stenting. This study aimed to evaluate the effectiveness of post-LSG staple line leak management at Middlemore Hospital.

Results

A total of 20/21 (95 %) patients now have resolved leaks following a mean of 75 days of treatment (median 47, range 9–187). The mean number of endoscopic procedures required was five. Inpatient stay and average duration till leak resolution has been notably reduced since the addition of customised stents. Clinically significant stent migration occurred in 19 % of primary stents.

Conclusion

The use of SEMS in conjunction with complementary endotherapy has shown to be both safe and effective in treating sleeve leaks; however, migration is the limiting factor for optimal management. Recent improvements in stent design, such as the one proposed in this paper, show promise in addressing this problem. Earlier use of SEMS seems to reduce the time till closure as well as the total hospital stay, as is apparent from our data.

Keywords

Sleeve gastrectomy Staple line leak Sleeve leak SEMS Stent Endoscopy 

Notes

Compliance with Ethical Standards

The study was approved by the Institutional research ethics committee and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Conflict of Interest

Dr. Ravinder Ogra declares an Honorarium received for an ANZ medical advisory meeting for Boston Scientific Corporation Australia in 2013. Dr. Tien Huey Lim and Thomas Southwell do not have any conflict of interest or declaration.

Informed Consent

Informed consent was obtained from all individual participants included in this study.

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Thomas Southwell
    • 1
  • Tien Huey Lim
    • 1
  • Ravinder Ogra
    • 1
  1. 1.Department of GastroenterologyMiddlemore HospitalAucklandNew Zealand

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