Abstract
Background
Postoperative leaks are a dreaded complication after bariatric surgery (BS). Its treatment is based on nutritional support and sepsis control by antibiotics, collections drainage and/or prosthesis, and/or surgery.
Objectives
The aim of this study is to report our experience with coated self-expandable endoscopic stents (SEES) for leaks treatment.
Setting
This study was performed in a University Hospital, (censored).
Methods
We performed a retrospective analysis of our BS database from January 2007 to December 2013. All patients with leak after BS treated with SEES were included.
Results
We identified 29 patients; 17 (59 %) were women, with median age of 37 (19–65) years, and preoperative body mass index of 40 (28.7–56-6) kg/m2. Nineteen (65.5 %) patients had a sleeve gastrectomy and 10 (34.5 %) a Roux-en-Y gastric bypass. All patients had a leak in the stapler line. Median time from surgery to leak diagnosis was 7 (1–51) days, and SEES were installed 8 (0–104) days after diagnosis. Twenty-one (72 %) patients also had abdominal exploration. Median length of SEES use was 60 (1–299) days. Patients who had SEES as primary treatment (with or without simultaneous reoperation) had a shorter leak closure time (50 [6–112] vs 109 [60–352] days; p = 0.008). Twenty-eight (96.5 %) patients successfully achieved leak closure with SEES. There were 16 migrations in 10 (34 %) patients, 1 (3 %) stent fracture, 1 opening of the blind end of alimentary limb (3 %), and 5 patients (17 %) required a second stent due to leak persistence.
Conclusions
SEES is a feasible, safe, and effective management of post BS leaks, although patients may also require prosthesis revision and abdominal exploration. Primary SEES placement is associated with a shorter leak resolution time.
Similar content being viewed by others
References
Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.
Sjöström L, Lindroos A-K, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.
Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. N Engl J Med. 2014;370(21):2002–13.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.
Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–36.
Lee S, Carmody B, Wolfe L, et al. Effect of location and speed of diagnosis on anastomotic leak outcomes in 3828 gastric bypass cases. J Gastrointest Surg. 2007;11(6):708–13.
Maher JW, Martin Hawver L, Pucci A, et al. Four hundred fifty consecutive laparoscopic Roux-en-Y gastric bypasses with no mortality and declining leak rates and lengths of stay in a bariatric training program. J Am Coll Surg. 2008;206(5):940–4. discussion 944–945.
Sakran N, Goitein D, Raziel A, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2013;27(1):240–5.
De Aretxabala X, Leon J, Wiedmaier G, et al. Gastric leak after sleeve gastrectomy: analysis of its management. Obes Surg. 2011;21(8):1232–7.
Spyropoulos C, Argentou M-I, Petsas T, et al. Management of gastrointestinal leaks after surgery for clinically severe obesity. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2012;8(5):609–15.
Yimcharoen P, Heneghan HM, Tariq N, et al. Endoscopic stent management of leaks and anastomotic strictures after foregut surgery. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2011;7(5):628–36.
Rajan PS, Bansal S, Balaji NS, et al. Role of endoscopic stents and selective minimal access drainage in oesophageal leaks: feasibility and outcome. Surg Endosc. 2014;28(8):2368–73.
Nguyen NT, Rudersdorf PD, Smith BR, et al. Management of gastrointestinal leaks after minimally invasive esophagectomy: conventional treatments vs. endoscopic stenting. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2011;15(11):1952–60.
Sharma P, Kozarek R, Practice Parameters Committee of American College of Gastroenterology. Role of esophageal stents in benign and malignant diseases. Am J Gastroenterol. 2010;105(2):258–73. quiz 274.
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 938–939.
Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, et al. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2012;8(1):8–19.
Clinical Issues Committee ASMBS. ASMBS guideline on the prevention and detection of gastrointestinal leak after gastric bypass including the role of imaging and surgical exploration. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2009;5(3):293–6.
Simon F, Siciliano I, Gillet A, et al. Gastric leak after laparoscopic sleeve gastrectomy: early covered self-expandable stent reduces healing time. Obes Surg. 2013;23(5):687–92.
Pequignot A, Fuks D, Verhaeghe P, et al. Is there a place for pigtail drains in the management of gastric leaks after laparoscopic sleeve gastrectomy? Obes Surg. 2012;22(5):712–20.
Tan JT, Kariyawasam S, Wijeratne T, et al. Diagnosis and management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg. 2010;20(4):403–9.
Lee SD, Khouzam MN, Kellum JM, et al. Selective, versus routine, upper gastrointestinal series leads to equal morbidity and reduced hospital stay in laparoscopic gastric bypass patients. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2007;3(4):413–6.
Csendes A, Braghetto I, León P, et al. Management of leaks after laparoscopic sleeve gastrectomy in patients with obesity. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2010;14(9):1343–8.
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.
Madan AK, Stoecklein HH, Ternovits CA, et al. Predictive value of upper gastrointestinal studies versus clinical signs for gastrointestinal leaks after laparoscopic gastric bypass. Surg Endosc. 2007;21(2):194–6.
Babor R, Talbot M, Tyndal A. Treatment of upper gastrointestinal leaks with a removable, covered, self-expanding metallic stent. Surg Laparosc Endosc Percutan Tech. 2009;19(1):e1–4.
El Mourad H, Himpens J, Verhofstadt J. Stent treatment for fistula after obesity surgery: results in 47 consecutive patients. Surg Endosc. 2013;27(3):808–16.
Swinnen J, Eisendrath P, Rigaux J, et al. Self-expandable metal stents for the treatment of benign upper GI leaks and perforations. Gastrointest Endosc. 2011;73(5):890–9.
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.
Sharaiha RZ, Kumta NA, Doukides TP, et al. Esophageal Stenting With Sutures: Time to Redefine our Standards? J Clin Gastroenterol. 2014.
Conflict of Interest
The authors declare that they have no conflict of interest. For this type of study, formal consent is not required.
Funding
There are no funding sources involved.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Quezada, N., Maiz, C., Daroch, D. et al. Effect of Early Use of Covered Self-Expandable Endoscopic Stent on the Treatment of Postoperative Stapler Line Leaks. OBES SURG 25, 1816–1821 (2015). https://doi.org/10.1007/s11695-015-1622-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-015-1622-x