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Stent treatment for fistula after obesity surgery: results in 47 consecutive patients

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Abstract

Background

Leaks occurring after weight loss operations constitute a therapeutic challenge. There is no consensus as to what comprises state-of-the-art management of leaks after bariatric surgery. We sought to determine the efficacy and possible adverse effects of endoluminal stenting for leaks after bariatric surgery.

Methods

We report our experience with the stent treatment of consecutive bariatric patients with a leak (retrospective cohort study). Between October 2005 and July 2010, 47 patients presented an acute leak after a bariatric procedure (61 % primary procedures, 39 % revisions). Fifteen patients were initially approached laparoscopically, and 32 were treated by nonoperative techniques. After adequate drainage and resuscitation, all 47 patients were treated by the endoscopic placement of a partially covered metallic stent, and later of a plastic stent inside the metallic prosthesis to facilitate removal. Both stents were then ablated 1 week later. Primary outcome measurement concerned healing of the fistula, as evidenced by radiographic imaging. Secondary outcomes were length of hospital stay and occurrence of peri- and postprocedural complications.

Results

There was no mortality. 41 patients (87.23 %) healed with stent treatment alone; 5 of the 6 persisting leaks healed with laparoscopic intervention (intention-to-treat success rate 96 %). Complication rate was 28.7 %. Length of hospital stay was mean ± standard deviation 22.4 ± 19.38 days for the patients treated by stent alone, and 23.4 ± 18.4 days for the patients requiring additional surgery (P = NS). One patient developed a stricture and required endoscopic dilation, and one is still awaiting surgical treatment.

Conclusions

Leaks after bariatric surgery can be treated safely and effectively by endoscopic stents. In cases of persisting leaks, laparoscopic intervention is successful in a majority of cases. Late strictures seldom occur.

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Disclosures

Drs. Haicam El Mourad and Johan Verhofstadt have no conflicts of interest or financial ties to disclose. Dr. J Himpens is a consultant with Ethicon Endosurgery and gives talks and organizes workshops for Gore, but there is no conflict of interest with the material presented in this article.

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Authors and Affiliations

  1. Obesity Surgery Department, AZ St. Blasius Hospital, 50 Kroonveldlaan, 9200, Dendermonde, Belgium

    Haicam El Mourad & Jacques Himpens

  2. Gastro-enterology Department, AZ St. Blasius Hospital, 50 Kroonveldlaan, 9200, Dendermonde, Belgium

    Johan Verhofstadt

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  1. Haicam El Mourad
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  2. Jacques Himpens
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Correspondence to Haicam El Mourad.

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El Mourad, H., Himpens, J. & Verhofstadt, J. Stent treatment for fistula after obesity surgery: results in 47 consecutive patients. Surg Endosc 27, 808–816 (2013). https://doi.org/10.1007/s00464-012-2517-8

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