Abstract
Background
Roux-en-Y gastric bypass (RYGB) consistently produces the most sustainable weight loss among common interventions for morbid obesity. Anastomotic leaks at the gastrojejunal (GJ) connection result in severe morbidity. We apply endoluminal negative pressure vacuum devices (EVD) to heal anastomotic leaks in a swine model.
Methods
RYGB was performed in 10 pigs (3 control, 7 experimental). GJ anastomoses were fashioned, and a 2-cm defect was made across the staple line. In controls, the defects remained open. In experimental pigs, the EVD was placed across the defect and kept at continuous 50 mmHg suction. All pigs were euthanized on postoperative day seven unless they displayed signs of peritonitis or sepsis. Fluoroscopy and necropsy were performed to assess a persistent leak, and tissue specimens were sent to histology to evaluate for degree of inflammation and ischemia.
Results
All three control pigs’ GJ anastomoses demonstrated evidence of a persistent leak. All seven experimental pigs with the EVD in place showed evidence that their leak had sealed at time of fluoroscopy (p value 0.008).
Conclusions
Endoluminal vacuum therapy is well tolerated in a swine model. GJ anastomotic leaks were consistently sealed with our device in place compared to controls. This therapy shows promise as a method to address GJ leaks in the bariatric population, and thus, we believe additional evaluation is warranted.
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Acknowledgments
The authors thank Dr. Mark Mentrikoski for his help with the histological scoring of all tissue specimens.
Funding
No grants were used in the completion of this study. Senior author, Daniel E. Kleiner MD, independently funded the study.
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Dr. Daniel E. Kleiner is the inventor of the described device and currently has a patent for this technology. He may at some point in the future have financial benefit for this device. There is no sponsoring company or financial agreements for this work. Drs. Sanford H. Feldman, Amber L. Shada, Lane A. Ritter and Rachel B. Scott have no conflicts of interest or financial ties to disclose.
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Scott, R.B., Ritter, L.A., Shada, A.L. et al. Endoluminal vacuum therapy for gastrojejunal anastomotic leaks after Roux-en-Y gastric bypass: a pilot study in a swine model. Surg Endosc 30, 5147–5152 (2016). https://doi.org/10.1007/s00464-016-4823-z
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DOI: https://doi.org/10.1007/s00464-016-4823-z