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Large Bariatric-Specific Stents and Over-the-Scope Clips in the Management of Post-Bariatric Surgery Leaks

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Abstract

Background

Endoscopic stents are successful in the management of surgical leaks; however, stent migration remains a significant problem. In this study, we present our approach depending on a large bariatrics-specific stent (Mega stent) and over-the-scope clips in the management of post-bariatric surgery leaks.

Methods

A retrospective analysis of all patients with post-bariatric surgery leaks treated at our institution using an approach reliant on Mega stents and over-the-scope clips was conducted. Potential factors associated with procedure success and occurrence of complications were also evaluated.

Results

A total of 81 stents were inserted in 62 patients with post-bariatric surgery leaks, 46 sleeve gastrectomies (73%) and 16 Roux-en-Y gastric bypass (27%). Over-the-scope clips were applied in 29 patients (46%). Leak closure was achieved in 51 patients (82%). Median number of procedures per patient was 3 (range 2–8). Complications included the following: stent migration (11/62, 18%), intolerance necessitating premature removal (7/62, 11%), esophageal stricture (8/62, 13%), bleeding (4/62, 6%), perforation (4/62, 6%). One stent-induced mortality was encountered (bleeding). The presence of open surgery (vs laparoscopic) was significantly associated with the occurrence of stent-induced complications (p 0.002).

Conclusion

The approach combining Mega stents and over-the-scope clips is highly effective in the management of post-bariatric surgery leaks and is associated with a low rate of stent migration and a low number of procedures and stents per patient. Mega stents, however, should be used with great caution due to the significant morbidity associated with their use.

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Authors and Affiliations

  1. Gastroenterology Department, Kasr-Alainy School of Medicine, Cairo University, Cairo, 11562, Egypt

    Hany Shehab

  2. General Surgery Department, Mansoura School of Medicine, Mansoura University, Mansoura, Egypt

    Emad Abdallah

  3. General Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt

    Khaled Gawdat

  4. Biostatistics and Epidemiology Department, National Cancer Institute, Cairo, Egypt

    Inas Elattar

Authors
  1. Hany Shehab
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  2. Emad Abdallah
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  3. Khaled Gawdat
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  4. Inas Elattar
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Corresponding author

Correspondence to Hany Shehab.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

Dr. Abdallah and Dr. Gawdat and dr. Elattar have no relevant conflicts of interest to disclose.

Dr. Shehab had consulted for stent designs not included in this study.

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Shehab, H., Abdallah, E., Gawdat, K. et al. Large Bariatric-Specific Stents and Over-the-Scope Clips in the Management of Post-Bariatric Surgery Leaks. OBES SURG 28, 15–24 (2018). https://doi.org/10.1007/s11695-017-2808-1

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  • DOI: https://doi.org/10.1007/s11695-017-2808-1

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