Obesity Surgery

, Volume 29, Issue 7, pp 2051–2058 | Cite as

Percutaneous Image-Guided Abdominal Interventions for Leaks and Fistulas Following Sleeve Gastrectomy and Roux-en-Y Gastric Bypass

  • Mariano PalermoEmail author
  • C. Federico Davrieux
  • Pablo A. Acquafresca
  • Michel Gagner
  • Edgardo Serra
  • Eduardo J. Hougthon
  • Caetano Finger
  • Mariano E. Giménez
Original Contributions



Bariatric surgery offers the only effective long-term weight loss therapy for morbidly obese patients. Numerous studies have demonstrated a mortality and morbidity reduction associated with weight loss surgery, but these interventions also have significant rates of complications. It is important for the bariatric surgeons to recognize these complications and acknowledge which of them can be solved in a minimally invasive manner in order to offer to patients the best treatment. The aim of this article was to review factors and success rates associated with percutaneous image guide abdominal interventions to treat the complications of bariatric surgery.

Materials and Methods

Retrospective descriptive study. Eighty-two patients with complications after bariatric surgery were included. Of these, 56 presented fistula with or without abdominal collection.


Of the total patients, 54% are male and 46% female. The average age was 49.4 (range 16–62). Of the 56 cases, 37 (66.1%) occurred after laparoscopic sleeve gastrectomy, and 19 (33.9%) post-Roux-en-Y gastric bypass. The fistula was resolved by percutaneous image guide abdominal interventions in 49 opportunities, of which 67% required only conservative treatment afterwards, the remaining 33% required endoscopic treatment with prostheses, fibrin sealants, and/or clips. No mortality was reported in the series.


Percutaneous image-guided abdominal interventions play a significant role in the treatment of complications following bariatric surgery. The minimally invasive treatment of fistula after bariatric surgery is safe and effective.


Obesity Bariatric surgery Surgical complications Percutaneous surgery Image-guided surgery 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent

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


  1. 1.
    Mokdad AH, Bowman BA, Ford ES, et al. The continuing epidemic of obesity and diabetes in the United States. JAMA. 2001;286(10):1195–200.CrossRefGoogle Scholar
  2. 2.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.CrossRefGoogle Scholar
  3. 3.
    Basa NR, Dutson E, Lewis C, et al. Laparoscopic transgastric removal of eroded adjustable band: a novel approach. Surg Obes Relat Dis. 2008;4(2):194–7.CrossRefGoogle Scholar
  4. 4.
    Schulman AR, Thompson CC. Complications of bariatric surgery: what you can expect to see in your GI practice. Am J Gastroenterol. 2017;112(11):1640–55.CrossRefGoogle Scholar
  5. 5.
    Weller WE, Hannan EL. Relationship between provider volume and postoperative complications for bariatric procedures in New York state. J Am Coll Surg. 2006;202(5):753–61.CrossRefGoogle Scholar
  6. 6.
    Escalona A, Devaud N, Boza C, et al. Gastrojejunal anastomotic stricture after Roux-en-Y gastric bypass: ambulatory management with the Savary-Gilliard dilator. Surg Endosc. 2007;21(5):765–8.CrossRefGoogle Scholar
  7. 7.
    Fernandez-Esparrach G, Bordas JM, Llach J, et al. Endoscopic dilation with Savary-Gilliard bougies of stomal strictures after laparosocopic gastric bypass in morbidly obese patients. Obes Surg. 2008;18(2):155–61.CrossRefGoogle Scholar
  8. 8.
    Csendes A, Burgos AM, Burdiles P. Incidence of anastomotic strictures after gastric bypass: a prospective consecutive routine endoscopic study 1 month and 17 months after surgery in 441 patients with morbid obesity. Obes Surg. 2009;19(3):269–73.CrossRefGoogle Scholar
  9. 9.
    Racu C, Dutson EP, Mehran A. Laparoscopic gastrojejunostomy revision: a novel approach to intractable marginal ulcer management. Surg Obes Relat Dis. 2010;6(5):557–8.CrossRefGoogle Scholar
  10. 10.
    Márquez MF, Ayza MF, Lozano RB, et al. Gastric leak after laparoscopic sleeve gastrectomy. Obes Surg. 2010;20(9):1306–11.CrossRefGoogle Scholar
  11. 11.
    Okazaki O, Bernardo WM, Brunaldi VO, et al. Efficacy and safety of stents in the treatment of fistula after bariatric surgery: a systematic review and meta-analysis. Obes Surg. 2018;28(6):1788–96.CrossRefGoogle Scholar
  12. 12.
    Cho M, Kaidar-Person O, Szomstein S, et al. Laparoscopic remnant gastrectomy: a novel approach to gastrogastric fistula after Roux-en-Y gastric bypass for morbid obesity. J Am Coll Surg. 2007;204(4):617–24.CrossRefGoogle Scholar
  13. 13.
    Boza C, Gamboa C, Salinas J, et al. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy: a case-control study and 3 years of follow-up. Surg Obes Relat Dis. 2012;8(3):243–9.CrossRefGoogle Scholar
  14. 14.
    Puli SR, Spofford IS, Thompson CC. Use of self-expandable stents in the treatment of bariatric surgery leaks: a systematic review and meta-analysis. Gastrointest Endosc. 2012;75(2):287–93.CrossRefGoogle Scholar
  15. 15.
    Eubanks S, Edwards CA, Fearing NM, et al. Use of endoscopic stents to treat anastomotic complications after bariatric surgery. J Am Coll Surg. 2008;206(5):935–8. discussion 938–9CrossRefGoogle Scholar
  16. 16.
    Iqbal A, Miedema B, Ramaswamy A, et al. Long-term outcome after endoscopic stent therapy for complications after bariatric surgery. Surg Endosc. 2011;25(2):515–20.CrossRefGoogle Scholar
  17. 17.
    Overcash WT. Natural orifice surgery (NOS) using StomaphyX for repair of gastric leaks after bariatric revisions. Obes Surg. 2008;18(7):882–5.CrossRefGoogle Scholar
  18. 18.
    Mikami D, Needleman B, Narula V, et al. Natural orifice surgery: initial US experience utilizing the StomaphyX device to reduce gastric pouches after roux-en-Y gastric bypass. Surg Endosc. 2010;24(1):223–8.CrossRefGoogle Scholar
  19. 19.
    de Wolfe MA, Bower CE. Using the StomaphyX (TM) endoplicator to treat a gastric bypass complication. JSLS. 2011;15(1):109–13.CrossRefGoogle Scholar
  20. 20.
    Kantsevoy SV, Thuluvath PJ. Successful closure of a chronic refractory gastrocutaneous fistula with a new endoscopic suturing device (with video). Gastrointest Endosc. 2012;75(3):688–90.CrossRefGoogle Scholar
  21. 21.
    Armengol-Miro JR, Dot J, Abu-Suboh Abadia M, et al. New endoscopic suturing device for closure of chronic gastrocutaneous fistula in an immunocompromised patient. Endoscopy. 2011;43 Suppl 2 UCTN:E403–4.CrossRefGoogle Scholar
  22. 22.
    Jirapinyo P, Watson RR, Thompson CC. Use of a novel endoscopic suturing device to treat recalcitrant marginal ulceration (with video). Gastrointest Endosc. 2012;76(2):435–9.CrossRefGoogle Scholar
  23. 23.
    Repici A, Arezzo A, De Caro G, et al. Clinical experience with a new endoscopic over-the-scope clip system for use in the GI tract. Dig Liver Dis. 2009;41(6):406–10.CrossRefGoogle Scholar
  24. 24.
    Conio M, Blanchi S, Repici A, et al. Use of an over-the-scope clip for endoscopic sealing of a gastric fistula after sleeve gastrectomy. Endoscopy. 2010;42(Suppl 2):E71–2.CrossRefGoogle Scholar
  25. 25.
    Kouklakis G, Zezos P, Liratzopoulos N, et al. Endoscopic treatment of a gastrocutaneous fistula using the over-the-scope-clip system: a case report. Diagn Ther Endosc. 2011;2011:384143.CrossRefGoogle Scholar
  26. 26.
    Aly A, Lim HK. The use of over the scope clip (OTSC) device for sleeve gastrectomy leak. J Gastrointest Surg. 2013;17(3):606–8.CrossRefGoogle Scholar
  27. 27.
    Surace M, Mercky P, Demarquay JF, et al. Endoscopic management of GI fistulae with the over-the-scope clip system (with video). Gastrointest Endosc. 2011;74(6):1416–9.CrossRefGoogle Scholar
  28. 28.
    Papavramidis ST, Eleftheriadis EE, Papavramidis TS, et al. Endoscopic management of gastrocutaneous fistula after bariatric surgery by using a fibrin sealant. Gastrointest Endosc. 2004;59(2):296–300.CrossRefGoogle Scholar
  29. 29.
    Papavramidis ST, Eleftheriadis EE, Apostolidis DN, et al. Endoscopic fibrin sealing of high-output non-healing gastrocutaneous fistulas after vertical gastroplasty in morbidly obese patients. Obes Surg. 2001;11(6):766–9.CrossRefGoogle Scholar
  30. 30.
    Papavramidis TS, Kotzampassi K, Kotidis E, et al. Endoscopic fibrin sealing of gastrocutaneous fistulas after sleeve gastrectomy and biliopancreatic diversion with duodenal switch. J Gastroenterol Hepatol. 2008;23(12):1802–5.CrossRefGoogle Scholar
  31. 31.
    Maluf-Filho F, Hondo F, Halwan B, et al. Endoscopic treatment of Roux-en-Y gastric bypass-related gastrocutaneous fistulas using a novel biomaterial. Surg Endosc. 2009;23(7):1541–5.CrossRefGoogle Scholar
  32. 32.
    Parikh M, Issa R, McCrillis A, et al. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg. 2013;257(2):231–7.CrossRefGoogle Scholar
  33. 33.
    Ballesta C, Berindoague R, Cabrera M, et al. Management of anastomotic leaks after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18(6):623–30.CrossRefGoogle Scholar
  34. 34.
    Gonzalez R, Sarr MG, Smith CD, et al. Diagnosis and contemporary management of anastomotic leaks after gastric bypass for obesity. J Am Coll Surg. 2007;204(1):47–55.CrossRefGoogle Scholar
  35. 35.
    Thaler K. Treatment of leaks and other bariatric complications with endoluminal stents. J Gastrointest Surg. 2009;13(9):1567–9.CrossRefGoogle Scholar
  36. 36.
    Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26(6):1509–15.CrossRefGoogle Scholar
  37. 37.
    Livingston EH, Ko CY. Assessing the relative contribution of individual risk factors on surgical outcome for gastric bypass surgery: a baseline probability analysis. J Surg Res. 2002;105(1):48–52.CrossRefGoogle Scholar
  38. 38.
    Baker RS, Foote J, Kemmeter P, et al. The science of stapling and leaks. Obes Surg. 2004;14(10):1290–8.CrossRefGoogle Scholar
  39. 39.
    Palermo M, Giménez M, Gagner M. Laparoscopic gastrointestinal surgery. Novel techniques, extending the limits, vol. 1-2. 1st ed. Pomona: AMOCA; 2015.Google Scholar
  40. 40.
    Palermo M, Acquafresca PA, Rogula T, et al. Late surgical complications after gastric by-pass: a literature review. Arq Bras Cir Dig. 2015;28(2):139–43.CrossRefGoogle Scholar
  41. 41.
    Silva LB, Moon RC, Teixeira AF, et al. Gastrobronchial fistula in sleeve gastrectomy and Roux-en-Y gastric bypass--a systematic review. Obes Surg. 2015;25(10):1959–65.CrossRefGoogle Scholar
  42. 42.
    Leeds SG, Burdick JS. Management of gastric leaks after sleeve gastrectomy with endoluminal vacuum (E-Vac) therapy. Surg Obes Relat Dis. 2016;12(7):1278–85.CrossRefGoogle Scholar
  43. 43.
    Schniewind B, Schafmayer C, Voehrs G, et al. Endoscopic endoluminal vacuum therapy is superior to other regimens in managing anastomotic leakage after esophagectomy: a comparative retrospective study. Surg Endosc. 2013;27(10):3883–90.CrossRefGoogle Scholar
  44. 44.
    Al-Sabah S, Ladouceur M, Christou N. Anastomotic leaks after bariatric surgery: it is the host response that matters. Surg Obes Relat Dis. 2008;4(2):152–7.CrossRefGoogle Scholar
  45. 45.
    Ali MR, Tichansky DS, Kothari SN, et al. Validation that a 1-year fellowship in minimally invasive and bariatric surgery can eliminate the learning curve for laparoscopic gastric bypass. Surg Endosc. 2010;24(1):138–44.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Mariano Palermo
    • 1
    • 2
    • 6
    Email author
  • C. Federico Davrieux
    • 1
    • 3
  • Pablo A. Acquafresca
    • 1
  • Michel Gagner
    • 4
    • 5
  • Edgardo Serra
    • 1
    • 2
  • Eduardo J. Hougthon
    • 1
  • Caetano Finger
    • 1
  • Mariano E. Giménez
    • 1
    • 6
    • 7
    • 8
  1. 1.DAICIM Foundation (Asistencia, Docencia e Investigación en Cirugía Invasiva Mínima)Buenos AiresArgentina
  2. 2.CIEN- DIAGNOMED Center Affiliated to the University of Buenos AiresBuenos AiresArgentina
  3. 3.Sanatorio de la Mujer, FishertonRosarioArgentina
  4. 4.Herbert Wertheim College of MedicineFlorida International UniversityMiamiUSA
  5. 5.Hopital du Sacre CoeurMontrealCanada
  6. 6.University of Buenos AiresBuenos AiresArgentina
  7. 7.University of StrasbourgStrasbourgFrance
  8. 8.IHU (Institut Hospitalo-Universitaire) - IRCAD (Institut de Recherche Contre les Cancers de l’Appareil Digestif)StrasbourgFrance

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