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Non-stenting treatment versus endoscopic stent placement in staple line leaks after laparoscopic sleeve gastrectomy

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Abstract

Purpose

Presentation of results of non-stenting treatment versus endoscopic stenting placement in gastric staple leaks after laparoscopic sleeve gastrectomy (LSG).

Methods

Between January 2007 and August 2020, 1371 eligible patients underwent LSG. After gastric leak detection, patients were classified into treatment groups A (endoscopic stent placement) and B (non-stenting management). Overall hospital stay, the time to complete gastric leak resolution and the incidence of further operative management constituted the main outcome measures. Statistical analysis included descriptive statistics and linear regression tests as needed.

Results

A total of 27 patients (19 F/8 M, median age: 44.8 years (range: 36–58) with median preoperative BMI: 43.5 kg/m2 (range: 37.0–48.7)) presented with gastric staple line leak (1.9%) — mean detection day 5.8 postop (range: 1–12). Eight patients enrolled in group A and 19 patients in group B. The mean hospital stay for group A was 41.2 days (range: 24–60) versus 15 days (range: 12–18) for group B (p < 0.001). Complete leakage resolution was observed at mean 42.4 days (range 25–60) for group A and 34.5 days (range: 28–40) for group B patients, (p = 0.025). Only 2 group A patients accomplished complete leak resolution without additional intervention. Five group A patients (62.5%) versus 4 group B patients (21.1%) needed operative intervention during the treatment course (p = 0.037).

Conclusions

Conservative, non-stenting treatment of staple line leaks after LSG is feasible and is associated with superior results in terms of hospital say and leak resolution in comparison to endoscopic stenting.

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Availability of data and material

Authors, Andreas Kiriakopoulos MD, Nefeli Kounatidis MS, Menenakos Ilias, Kostrova Maria MD, Zografos Konstantinos MD, Evangelos Menenakos MD, declare that the data of the study are available upon reasonable request.

Code availability

Authors, Andreas Kiriakopoulos MD, Nefeli Kounatidis MS, Menenakos Ilias, Kostrova Maria MD, Zografos Konstantinos MD, Evangelos Menenakos MD, declare that all software applications are available upon reasonable request.

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Acknowledgements

We, authors: Andreas Kiriakopoulos MD, Nefeli Kounatidis MS, Menenakos Ilias, Kostrova Maria MD, Zografos Konstantinos MD, Evangelos Menenakos MD, declare that no other personal assistance has taken place in creating this work.

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Author notes

  1. Andreas Kiriakopoulos

    Present address: 5th Surgical Clinic, “Evgenideion Hospital”, National and Kapodistrian University of Athens School of Medicine, Papadiamantopoulou 20 Str., PO: 11528, Athens, Greece

Authors and Affiliations

  1. 5th Surgical Clinic, “Evgenideion Hospital”, National and Kapodistrian University of Athens School of Medicine, Papadiamantopoulou 20 Str., PO: 11528, Athens, Greece

    Nefeli Kounatidis, Konstantinos Zografos & Evangelos Menenakos

  2. Actuarial Science, Department of Statistics, London School of Economics, London, UK

    Ilias Menenakos & Maria Kostrova

  3. 1st Clinic, Division of Morbid Obesity and Metabolic Surgery, “Ippokrateion Hospital”, National and Kapodistrian University of Athens School of Medicine, Athens, Greece

    Evangelos Menenakos

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Contributions

Andreas Kiriakopoulos: study conception and design, analysis and interpretation of data, drafting of manuscript, critical revision of manuscript. Nefeli Kounatidis: acquisition of data, drafting of manuscript. Menenakos Ilias: study conception and design, acquisition of data, analysis and interpretation of data. Kostrova Maria: study conception and design, acquisition of data, drafting of manuscript. Zografos Konstantinos: acquisition of data, drafting of manuscript, critical revision of manuscript. Menenakos Evangelos: study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision of manuscript.

Corresponding author

Correspondence to Andreas Kiriakopoulos.

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Authors, Andreas Kiriakopoulos MD, Nefeli Kounatidis MS, Menenakos Ilias, Kostrova Maria MD, Zografos Konstantinos MD, Evangelos Menenakos MD, declare that all participants have consent to this research study.

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Authors, Andreas Kiriakopoulos MD, Nefeli Kounatidis MS, Menenakos Ilias, Kostrova Maria MD, Zografos Konstantinos MD, Evangelos Menenakos MD, declare that we consent to the publication of our research study.

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Kiriakopoulos, A., Kounatidis, N., Menenakos, I. et al. Non-stenting treatment versus endoscopic stent placement in staple line leaks after laparoscopic sleeve gastrectomy. Langenbecks Arch Surg 407, 1863–1872 (2022). https://doi.org/10.1007/s00423-022-02498-5

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