Skip to main content
SpringerLink
Log in
Book cover

Emergency Surgery in Obese Patients pp 175–187Cite as

Emergencies After Bariatric Surgery: The Role of Flexible Endoscopy and Interventional Radiology

  • Chapter

  • 491 Accesses

Part of the book series: Updates in Surgery ((UPDATESSURG))

Abstract

Nowadays bariatric surgery is the most valid and safe method to treat severe cases of obesity that are refractory to the conventional restrictive dietary approaches. However, along with the increasing number of procedures performed, the incidence of post-bariatric surgery complications is also rising. The clinical and radiological work-up is difficult and variable, and treatment is both laparoscopic and endoscopic, with better efficacy and faster recovery with endoscopy. Unfortunately, there is still no clear evidence or guidelines that can help the physicians and surgeons to solve and manage the high rates of morbidity and mortality. In this chapter, the authors illustrate the most commonly adopted endoscopic and radiologic approaches and propose a therapeutic algorithm for post-bariatric surgical complications.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Longitudinal Assessment of Bariatric Surgery (LABS) Consortium, Flum DR, Belle SH, King WC, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361:445–54.

    Article  Google Scholar 

  2. Parikh MS, Laker S, Weiner M, et al. Objective comparison of complications resulting from laparoscopic bariatric procedures. J Am Coll Surg. 2006;202:252–61.

    Article  Google Scholar 

  3. Donatelli G, Dumont JL, Cereatti F, et al. Treatment of leaks following sleeve gastrectomy by endoscopic internal drainage (EID). Obes Surg. 2015;25:1293–301.

    Article  CAS  Google Scholar 

  4. Silecchia G, Iossa A. Complications of staple line and anastomoses following laparoscopic bariatric surgery. Ann Gastroenterol. 2017;31:56–64.

    PubMed  PubMed Central  Google Scholar 

  5. Cai JX, Schweitzer MA, Kumbhari V. Endoscopic management of bariatric surgery complications. Surg Laparosc Endosc Percutan Tech. 2016;26:93–101.

    Article  Google Scholar 

  6. Ma IT, Madura JA. Gastrointestinal complications after bariatric surgery. Gastroenterol Hepatol (N Y). 2015;11:526–35.

    Google Scholar 

  7. Ferreira LE, Song LM, Baron TH. Management of acute postoperative hemorrhage in the bariatric patient. Gastrointest Endosc Clin N Am. 2011;21:287–94.

    Article  Google Scholar 

  8. Eisendrath P, Deviere J. Major complications of bariatric surgery: endoscopy as first-line treatment. Nat Rev Gastroenterol Hepatol. 2015;12:701–10.

    Article  Google Scholar 

  9. Imberti D, Baldini E, Pierfranceschi MG, et al. Prophylaxis of venous thromboembolism with low molecular weight heparin in bariatric surgery: a prospective, randomized pilot study evaluating two doses of parnaparin (BAFLUX Study). Obes Surg. 2014;24:284–91.

    Article  Google Scholar 

  10. Souto-Rodríguez R, Alvarez-Sánchez MV. Endoluminal solutions to bariatric surgery complications: a review with a focus on technical aspects and results. World J Gastrointest Endosc. 2017;9:105–26.

    Article  Google Scholar 

  11. Karstensen JG, Ebigbo A, Aabakken L, et al. Nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Cascade Guideline. Endosc Int Open. 2018;6:E1256–63.

    Article  Google Scholar 

  12. Cipolletta L, Cipolletta F, Granata A, et al. What is the best endoscopic strategy in acute non-variceal gastrointestinal bleeding? Curr Treat Options Gastroenterol. 2018;16:363–75.

    Article  Google Scholar 

  13. Donatelli G, Fuks D, Tabchouri N, Pourcher G. Seal or drain? Endoscopic management of leaks following sleeve gastrectomy. Surg Innov. 2018;25:5–6.

    Article  Google Scholar 

  14. Perez M, Brunaud L, Kedaifa S, et al. Does anatomy explain the origin of a leak after sleeve gastrectomy? Obes Surg. 2014;24:1717–23.

    Article  Google Scholar 

  15. Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, Arvidsson D, Baker RS, et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8:8–19.

    Google Scholar 

  16. Kumar N, Thompson CC. Endoscopic management of complications after gastrointestinal weight loss surgery. Clin Gastroenterol Hepatol. 2013;11:343–53.

    Article  Google Scholar 

  17. Bemelman WA, Baron TH. Endoscopic management of transmural defects, including leaks, perforations, and fistulae. Gastroenterology. 2018;154:1938–46.e1.

    Article  Google Scholar 

  18. De Palma GD, Forestieri P. Role of endoscopy in the bariatric surgery of patients. World J Gastroenterol. 2014;20:7777–84.

    Article  Google Scholar 

  19. Lorenzo D, Guilbaud T, Gonzalez JM, et al. Endoscopic treatment of fistulas after sleeve gastrectomy: a comparison of internal drainage versus closure. Gastrointest Endosc. 2018;87:429–37.

    Article  Google Scholar 

  20. 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. 2017;27:530–5.

    Article  Google Scholar 

  21. Donatelli G, Fuks D, Cereatti F, et al. Endoscopic transmural management of abdominal fluid collection following gastrointestinal, bariatric, and hepato-bilio-pancreatic surgery. Surg Endosc. 2018;32:2281–7.

    Article  Google Scholar 

  22. Möschler O, Nies C, Mueller MK. Endoscopic vacuum therapy for esophageal perforations and leakages. Endosc Int Open. 2015;3:E554–8.

    Article  Google Scholar 

  23. Leeds SG, Burdick JS. Management of gastric leaks after sleeve gastrectomy with endoluminal vacuum (E-Vac) therapy. Surg Obes Relat Dis. 2016;12:1278–85.

    Article  Google Scholar 

  24. 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;28:1788–96.

    Article  Google Scholar 

  25. DaVee T, Irani S, Leggett CL, et al. Stent-in-stent technique for removal of embedded partially covered self-expanding metal stents. Surg Endosc. 2016;30:2332–41.

    Article  Google Scholar 

  26. Tringali A, Bove V, Perri V, et al. Endoscopic treatment of post-laparoscopic sleeve gastrectomy leaks using a specifically designed metal stent. Endoscopy. 2017;49:64–8.

    Article  Google Scholar 

  27. Bick BL, Imperiale TF, Johnson CS, DeWitt JM. Endoscopic suturing of esophageal fully covered self-expanding metal stents reduces rates of stent migration. Gastrointest Endosc. 2017;86:1015–21.

    Article  Google Scholar 

  28. Law R, Prabhu A, Fujii-Lau L, et al. Stent migration following endoscopic suture fixation of esophageal self-expandable metal stents: a systematic review and meta-analysis. Surg Endosc. 2018;32:675–81.

    Article  Google Scholar 

  29. Stavropoulos SN, Modayil R, Friedel D. Current applications of endoscopic suturing. World J Gastrointest Endosc. 2015;7:777–89.

    Article  Google Scholar 

  30. Sharaiha RZ, Kumta NA, DeFilippis EM, et al. A large multicenter experience with endoscopic suturing for management of gastrointestinal defects and stent anchorage in 122 patients: a retrospective review. J Clin Gastroenterol. 2016;50:388–92.

    PubMed  Google Scholar 

  31. Cai JX, Khashab MA, Okolo PI 3rd, et al. Full-thickness endoscopic suturing of staple-line leaks following laparoscopic sleeve gastrectomy. Endoscopy. 2014;46(Suppl 1):E623–4.

    PubMed  Google Scholar 

  32. Schulman AR, Huseini M, Thompson CC. Endoscopic sleeve gastroplasty of the remnant stomach in Roux-en-Y gastric bypass: a novel approach to a gastrogastric fistula with weight regain. Endoscopy. 2018;50:E132–3.

    Article  Google Scholar 

  33. Granata A, Amata M, Traina M. Esophagojejunal anastomotic dehiscence successfully repaired by endoluminal suture and stent positioning: report of a mini-invasive approach. Dig Endosc. 2018;30:535–6.

    Article  Google Scholar 

  34. Cheriyan D, Enns R. Over-the-scope clip in the management of GI defects. Gastrointest Endosc. 2014;80:623–5.

    Article  Google Scholar 

  35. Keren D, Eyal O, Sroka G, et al. Over-the-Scope Clip (OTSC) System for sleeve gastrectomy leaks. Obes Surg. 2015;25:1358–63.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Endoscopy Service, ISMETT–Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy

    Antonio Granata, Michele Amata, Valeria Provenzano & Mario Traina

Authors
  1. Antonio Granata
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michele Amata
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Valeria Provenzano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mario Traina
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antonio Granata .

Editor information

Editors and Affiliations

  1. Department of Biomedical Sciences Luigi Sacco, University of Milan, Milan, Italy

    Diego Foschi

  2. Department of Human Pathology of Adult and Evolutive Age, University of Messina, Messina, Italy

    Giuseppe Navarra

1 Electronic Supplementary Material

The “drain” technique in a leak following a mini-gastric by-pass. Through placement of pigtail plastic stents, endoscopic internal drainage allows direct reabsorption of the wall and adjacent collection (MP4 126609 kb)

A post-LSG leak successfully treated with a combination therapy. After visualization of the wall defect, the endoluminal suturing system permits “closing” and the FCSEMS avoids the recurrent contact damage, providing better local conditions for a faster and solid healing (MP4 266849 kb)

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Cite this chapter

Granata, A., Amata, M., Provenzano, V., Traina, M. (2020). Emergencies After Bariatric Surgery: The Role of Flexible Endoscopy and Interventional Radiology. In: Foschi, D., Navarra, G. (eds) Emergency Surgery in Obese Patients. Updates in Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-17305-0_24

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-17305-0_24

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-17304-3

  • Online ISBN: 978-3-030-17305-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation