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Removable and repositionable covered metal self-expandable stents for leaks after upper gastrointestinal surgery: experiences in a tertiary referral hospital

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Abstract

Background

Anastomotic leakages are severe complications of upper gastrointestinal surgery with serious morbidity and mortality. Until recently, only abscess drainage was possible. Since 2007, removable and repositionable covered metal self-expandable stents (RReCoMSeS) have been used in our hospital to cover leaks.

Methods

Patients with postsurgical gastrointestinal leaks treated with RReCoMSeS between January 2007 and March 2010 were retrospectively evaluated and described.

Results

Twenty-six patients were treated with RReCoMSeS (totally covered Choo/Hanaro and partially covered Endoflex stents). Included patients had anastomotic leaks after esophagectomy (15) and bariatric surgery (11). Overall successful sealing of the leak occurred in 81 % (including multiple procedures). In total 33 RReCoMSeS were used (mean 1.3 stents and 1.7 procedures per patient). Twenty-one of 33 RReCoMSeS succeeded in sealing the leak (64 %). Migration occurred in 24 % RReCoMSeS, and 9 % disintegrated. One stent (3 %) caused a perforation.

Conclusions

RReCoMSeS are a safe alternative for treating postsurgical leaks in the upper gastrointestinal tract. In 81 % of patients and with 64 % of the inserted stents, leaks were sealed successfully, with few complications. Fewer stents per patient were needed thanks to their repositionability. Stent migration is a major problem.

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Acknowledgments

The authors thank E. J. Schoon, MD, PhD, and J. van Spreeuwel, MD, PhD, for their skillful endoscopic contribution.

Disclosures

The bariatric department of our hospital and Dr. F. J. Smulders received an education grant from Covidien for the year 2011. Drs. Stronkhorst, Nieuwenhuijzen, Gilissen, and Leenders have no conflicts of interest or financial ties to disclose.

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Author notes

  1. Bart J. M. Leenders

    Present address: VieCuri Medical Center, Venlo, The Netherlands

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands

    Bart J. M. Leenders, Arnold Stronkhorst & Lennard P. L. Gilissen

  2. Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands

    Frans J. Smulders & Grard A. Nieuwenhuijzen

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  1. Bart J. M. Leenders
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  2. Arnold Stronkhorst
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  3. Frans J. Smulders
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  4. Grard A. Nieuwenhuijzen
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  5. Lennard P. L. Gilissen
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Correspondence to Bart J. M. Leenders.

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Leenders, B.J.M., Stronkhorst, A., Smulders, F.J. et al. Removable and repositionable covered metal self-expandable stents for leaks after upper gastrointestinal surgery: experiences in a tertiary referral hospital. Surg Endosc 27, 2751–2759 (2013). https://doi.org/10.1007/s00464-013-2802-1

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