Skip to main content
SpringerLink
Log in

Role of Percutaneous Glue Treatment After Persisting Leak After Laparoscopic Sleeve Gastrectomy

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Over the years, many treatment modes have been attempted for gastrocutaneous fistula (GCF) after laparoscopic sleeve gastrectomy (LSG). Minimally invasive techniques for GCF treatment include stent placement and radiological percutaneous glue treatment (GT).

Material and Method

Ten patients underwent a radiological acrylate mixed with contrast medium GT combined or not with other treatment strategies such as relaparoscopy, ultrasound, or computerized tomography scan (CT scan)-guided drain and endoscopic stent placement.

Results

Ten patients (mean age 47.1 years, range 64–29) were treated by percutaneous injection of glue after LSG leak. Body mass index (BMI) was 42.2 kg/m2 ± 6.7 at the time of LSG surgery. Mean time between LSG and leak diagnosis was 12 days (range 4–31 days). GT was only effective when performed after endoscopic stent placement (80 % resolution). With this regimen, five patients required a laparoscopic Roux limb placement. All fistulas eventually healed a mean of 75 days (range 29–293 days) after GCF diagnosis.

Conclusions

Percutaneous glue treatment alone does not seem to provide adequate results. Stenting previous to the glue treatment allows for better results.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Deitel M, Gagner M, Erickson AL, et al. Third international summit: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2011;7:749–59.

    Article  PubMed  Google Scholar 

  2. Sanchez-Santos R, Masdevall C, Baltasar A, et al. Short- and mid-term outcomes of sleeve gastrectomy for morbid obesity: the experience of the Spanish National Registry. Obes Surg. 2009;19(9):1203–10.

    Article  PubMed  Google Scholar 

  3. Stroh C, Birk D, Flade-Kuthe R, et al. Results of sleeve gastrectomy—data from a Nationwide Survey on Bariatric Surgery in Germany. Obes Surg. 2009;19:632–40.

    Article  PubMed  Google Scholar 

  4. Boza C, Salinas J, Salgado N, et al. Laparoscopic sleeve gastrectomy as a stand-alone procedure for morbid obesity: report of 1,000 cases and 3-year follow-up. Obes Surg. 2012;22:866–71.

    Article  PubMed  Google Scholar 

  5. Csendes A, Braghetto I, León P, et al. Management of leaks after laparoscopic sleeve gastrectomy in patients with obesity. J Gastrointest Surg. 2010;14(19):1343–8.

    Article  PubMed  Google Scholar 

  6. Zonca P, Cambal M, Jacobi CA. Complicated course after sleeve gastrectomy for obesity. Bratisl Lek Listy. 2010;111(4):231–4.

    CAS  PubMed  Google Scholar 

  7. Madan AK, Lanier B, Tichansky DS. Laparoscopic repair of gastrointestinal leaks after laparoscopic gastric bypass. Am Surg. 2006;72(7):586–90.

    PubMed  Google Scholar 

  8. Chryssostalis A, Rosa I, Pileire G, et al. Closure of refractory gastrocutaneous fistula using endoclipping. Endoscopy. 2005;37:924.

    Article  CAS  PubMed  Google Scholar 

  9. Toussaint E, Eisendrath P, Kwan V, et al. Endoscopic treatment of postoperative enterocutaneous fistulas after bariatric surgery with the use of a fistula plug: report of five cases. Endoscopy. 2009;41(6):560–3.

    Article  CAS  PubMed  Google Scholar 

  10. Ramón Rábago L, Moral I, Delgado M, et al. Endoscopic treatment of gastrointestinal fistulas with biological fibrin glue. Gastroenterol Hepatol. 2006;29(7):390–6.

    Article  PubMed  Google Scholar 

  11. Salinas A, Baptista A, Santiago E, et al. Self-expandable metal stents to treat gastric leaks. Surg Obes Relat Dis. 2006;2:570–2.

    Article  PubMed  Google Scholar 

  12. Blackmon SH, Santora R, Schwarz P, et al. Utility of removable esophageal covered self-expanding metal stents for leak and fistula management. Ann Thorac Surg. 2010;89(3):931–7.

    Article  PubMed  Google Scholar 

  13. Casella G, Soricelli E, Rizzello M, et al. Non surgical treatment of staple line leaks after laparoscopic sleeve gastrectomy. Obes Surg. 2009;19(7):821–6.

    Article  CAS  PubMed  Google Scholar 

  14. Merrifield BF, Lautz D, Thompson CC. Endoscopic repair of gastric leaks after Roux-en-Y gastric bypass: a less invasive approach. Gastrointest Endosc. 2006;63(4):710–4.

    Article  PubMed  Google Scholar 

  15. Pequignot A, Fuks D, Verhaeghe P, et al. Is there a place for pigtail drains in the management of gastric leaks alter laparoscopic sleeve gastrectomy? Obes Surg. 2012;22(5):712–20.

    Article  CAS  PubMed  Google Scholar 

  16. van de Vrande S, Himpens J, El Mourad H, Debaerdemaeker R, Leman G. Management of chronic proximal fistulas after sleeve gastrectomy by laparoscopic Roux-limb placement. Surg Obes Relat Dis. 2013 16.

  17. Kim W, Song KY, Lee HJ, et al. The impact of comorbidity on surgical outcomes in laparoscopy assisted distal gastrectomy: a retrospective analysis of multicenter results. Ann Surg. 2008;248(5):793–9.

    Article  PubMed  Google Scholar 

  18. Kunisaki C, Makino H, Takagawa R, et al. Predictive factors for surgical complications of laparoscopy-assisted distal gastrectomy for gastric cancer. Surg Endosc. 2009;23(9):2085–93.

    Article  PubMed  Google Scholar 

  19. Menenakos E, Stamou KM, Albanopoulos K, et al. Laparoscopic sleeve gastrectomy performed with intent to treat morbid obesity: a prospective single-center study of 261 patients with a median follow-up of 1 year. Obes Surg. 2010;20(23):276–82.

    Article  PubMed  Google Scholar 

  20. El Mourad H, Himpens J, Verhofstadt J. Stent treatment for fistula alter obesity surgery: results in 47 consecutive patients. Surg Endosc. 2013;27(3):808–16.

    Article  PubMed  Google Scholar 

  21. Rolandelli R, Roslyn JJ. Surgical management and treatment of sepsis associated with gastrointestinal fistulas. Surg Clin North Am. 1996;76:1111–22.

    Article  CAS  PubMed  Google Scholar 

  22. Rosenthal RJ, International Sleeve Gastrectomy Expert Panel. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8(1):8–19.

    Article  PubMed  Google Scholar 

  23. Abraham A, Virdi RP, Rajan D, et al. Gastrobronchial fistula following laparoscopic sleeve gastrectomy. BMJ Case Rep. 2012;12:2012.

    Google Scholar 

  24. Kwon SH, Oh JH, Kim HJ, et al. Interventional management of gastrointestinal fistulas. Korean J Radiol. 2008;9(6):541–9.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Sakran N, Assalia A, Keidar A, et al. Gastrobronchial fistula as a complication of bariatric surgery: a series of 6 cases. Obes Facts. 2012;5(4):538–45.

    Article  PubMed  Google Scholar 

  26. Kellogg TA, Swan T, Leslie DA, Buchwald H, Ikramuddin S. Patterns of readmission and reoperation within 90 days.

  27. Dudrick SJ, Maharaj AR, McKelvey AA. Artificial nutritional support in patients with gastrointestinal fistulas. World J Surg. 1999;23:570–6.

    Article  CAS  PubMed  Google Scholar 

  28. Campos JM, Siqueira LT, Meira MR, et al. Gastrobronchial fistula as a rare complication of gastroplasty for obesity: a report of two cases. J Bras Pneumol. 2007;33(4):475–9.

    Article  PubMed  Google Scholar 

  29. Chin PL. Gastrobronchial fistula as a complication of laparoscopic adjustable gastric banding. Surg Obes Relat Dis. 2008;4(5):671–3.

    Article  PubMed  Google Scholar 

  30. Fuks D, Dumont F, Berna P, et al. Case report—complex management of a postoperative bronchogastric fistula after laparoscopic sleeve gastrectomy. Obes Surg. 2009;19(2):261–4.

    Article  PubMed  Google Scholar 

  31. Campos JM, Siqueira LT, Ferraz AA, et al. Gastrobronchial fistula after obesity surgery. J Am Coll Surg. 2007;204(4):711.

    Article  PubMed  Google Scholar 

  32. Serra C, Baltasar A, Andreo L, et al. Treatment of gastric leaks with coated self-expanding stents after sleeve gastrectomy. Obes Surg. 2007;17(7):866–72.

    Article  PubMed  Google Scholar 

  33. Papavramidis TS, Kotzampassi K, Kotidis E, et al. Endoscopic fibrin sealing of gastrocutaneous fistulas after sleeve gastrectomy and biliopancreatic diversion with duodenal switch. J Gastroenterol Hepatol. 2008;23(12):1802–5.

    Article  PubMed  Google Scholar 

  34. Eisendrath P, Cremer M, Himpens J, et al. Endotherapy including temporary stenting of fistulas of the upper gastrointestinal tract after laparoscopic bariatric surgery. Endoscopy. 2007;39(7):625–30.

    Article  CAS  PubMed  Google Scholar 

  35. 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.

    Article  CAS  PubMed  Google Scholar 

  36. Taheri MR, Singh H, Duerksen DR. Peritonitis after gastrostomy tube replacement: a case series and review of literature. J Parenter Enter Nutr. 2011;35(1):56–60.

    Article  Google Scholar 

  37. Rolleston HD, Oliver MW. Secondary parotitis due to oral starvation in the medical treatment of gastric ulcer. Br Med J. 1909;1(2526):1296–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Papavramidis ST, Eleftheriadis EE, Papavramidis TS, et al. Endoscopic management of gastrocutaneous fistulas after bariatric surgery by using a fibrin sealant. Gastrointest Endosc. 2004;59:296–300.

    Article  PubMed  Google Scholar 

  39. Eleftheriadis E, Kotzampassi K. Therapeutic fistuloscopy: an alternative approach in the management of postoperative fistulas. Dig Surg. 2002;19:230–5.

    Article  PubMed  Google Scholar 

  40. Papavramidis ST, Eleftheriadis EE, Apostolidis DN, et al. Endoscopic fibrin sealing of high-output non-healing gastrocutaneous fistulas after vertical gastroplasty in morbidly obese patients. Obes Surg. 2001;11:766–9.

    Article  CAS  PubMed  Google Scholar 

  41. Campos JM, Pereira EF, Evangelista LF, et al. Gastrobronchial fistula after sleeve gastrectomy and gastric bypass: endoscopic management and prevention. Obes Surg. 2011;21(10):1520–9.

    Article  PubMed  Google Scholar 

  42. Seven G, Irani S, Ross AS, et al. Partially versus fully covered self-expanding metal stents for benign and malignant esophageal conditions: a single center experience. Surg Endosc. 2013;27:2185–92.

    Article  PubMed  Google Scholar 

  43. Vilallonga R, Fort JM, Himpens J. Chronic fistula after laparoscopic vertical gastrectomy. Cir Esp. 2014;92:700–1.

    Article  PubMed  Google Scholar 

  44. Vilallonga R, Himpens J, van de Vrande S. Laparoscopic Roux limb placement for the management of chronic proximal fistulas after sleeve gastrectomy: technical aspects. Surg Endosc. 2015;29:414–6.

    Article  PubMed  Google Scholar 

Download references

Authors’ Contributions

Dr. JH and Dr. RV prepared and collected the database and wrote the manuscript. Dr. SVDV and Dr. BB reviewed the patients’ data and analyzed the data. They also did a critical review of the manuscript. Dr. JB reviewed the manuscript and analyzed the data.

Author information

Authors and Affiliations

  1. Division of Bariatric Surgery, AZ St-Blasius, Kroonveldlaan 52, 9200, Dendermonde, Belgium

    Ramon Vilallonga, Jacques Himpens, Barbara Bosch, Simon van de Vrande & Johan Bafort

Authors
  1. Ramon Vilallonga
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jacques Himpens
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Barbara Bosch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Simon van de Vrande
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Johan Bafort
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ramon Vilallonga.

Ethics declarations

Conflict of Interest Statement and Ethical Approval

All the authors have no conflicts of interest for the publication of this paper and all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vilallonga, R., Himpens, J., Bosch, B. et al. Role of Percutaneous Glue Treatment After Persisting Leak After Laparoscopic Sleeve Gastrectomy. OBES SURG 26, 1378–1383 (2016). https://doi.org/10.1007/s11695-015-1959-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-015-1959-1

Keywords

Search

Navigation