Abstract
Background
Roux-en-Y gastric bypass (RYGB) is complicated by a leak in 0–4.3% of cases. Treatment by fully covered stents has been reported to be associated with some life-threatening complications. We report our experience of insertion of double pigtail stents.
Methods
Thirty-three patients (20M, 43 years-20/65), presenting with a leak at an average of 10 days after RYGB (4–35), were treated by double pigtail stent insertion and a nasojejunal feeding tube. Sixty percent of these patients had undergone surgical drainage prior to stenting for control of sepsis. Thirty leaks were located at the top of staple line and three at the gastro-jejunal anastomosis. At a 4-weekly follow-up, ablation or re-stenting was performed depending on status of fistula closure and patients were placed on normal diet.
Results
At the first follow-up, 10/33 fistulae healed, one patient presented with clinical failure (3%) and needed surgery, and 22/33were re-stented. Twenty-one out of these 22 developed a secondary sub-clinical gastro-gastric fistula and one, instead, developed complex (gastro-gastric, gastro-colic) fistula. All (22) primary fistulae healed following four more weeks of treatment. Average treatment duration was of 61 days (28–99). Thirty-two patients (97%) at a follow-up of 1–33 months are asymptomatic.
Conclusions
Leaks following RYGB can be successfully and safely managed by double pigtail stents. Upper gastric staple line leaks are responsible for the formation of a secondary sub-clinic gastro-gastric fistula which needs no additional treatment.
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Electronic Supplementary Material
Video 1
Diagnosis of fistula below the cardia at the level of staple line following RYGB communicating with a 5 cm collection. Internal drainage by the use of double pigtail stent. (MOV 8152 kb)
Video 2
Secondary Gastro-gastric fistula, at endoscopic contrast study, appeared after 4 weeks of endoscopic internal drainage by pigtail of a leak localized in the upper part of the stomach staple line. (MOV 5390 kb)
Video 3
Endoscopy vision of secondary gastro-gastric fistula (<5 mm) following double pigtail drainage of leak localized at the upper part of gastric staple line. (MOV 14307 kb)
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Donatelli, G., Dumont, JL., Dhumane, P. et al. Double Pigtail Stent Insertion for Healing of Leaks Following Roux-en-Y Gastric Bypass. Our Experience (with Videos). OBES SURG 27, 530–535 (2017). https://doi.org/10.1007/s11695-016-2465-9
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DOI: https://doi.org/10.1007/s11695-016-2465-9