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Endoscopic Internal Drainage Coupled to Prompt External Drainage Mobilization Is an Effective Approach for the Treatment of Complicated Cases of Sleeve Gastrectomy

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Abstract

Introduction

Despite advances in treating gastric staple line leaks after bariatric surgical procedures, chronic leaks have been reported. Failure of their treatment frequently leads to radical surgery. We aimed to describe a strategy for preventing occurrence of chronic gastric leaks after complicated sleeve gastrectomy in patients necessitating relaparoscopy and external drainage as a first step of gastric leak management.

Methods

Data from 14 consecutive patients admitted for gastric leak after laparoscopic sleeve gastrectomy were prospectively collected and retrospectively analyzed. Patients included underwent relaparoscopy and external drainage as first step of management.

Results

Median time to gastric leak detection was 4 days. Emergency relaparoscopy allowed peritoneal lavage and external drainage placement next to the leak. Median time between surgery and endoscopic internal drainage (EID) was 4 days. Progressive external drainage mobilization started after 2 days. Control endoscopy was performed every 4 weeks until healing. A median interval of 112 days was necessary before healing in 13 patients. Thirteen patients (92.8%) had no gastric leak recurrence at 1 year. In one patient, EID was considerably delayed and external drainage mobilization prolonged, leading to chronic gastric leak and total gastrectomy after 18 months.

Conclusion

This study reports for the first time a well-standardized protocol of early EID after relaparoscopy coupled to rapid external drainage removal for effectively treating complicated cases of sleeve gastrectomy. Bariatric surgeons should be aware of such therapeutic strategies and include them in their arsenal against postoperative gastric staple line leaks in severely obese patients.

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References

  1. Borrell LN, Samuel L. Body mass index categories and mortality risk in US adults: the effect of overweight and obesity on advancing death. Am J Public Health. 2014;104:512–9.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Yatsuya H, Li Y, Hilawe EH, et al. Global trend in overweight and obesity and its association with cardiovascular disease incidence. Circ J. 2014;78:2807–18.

    Article  PubMed  Google Scholar 

  3. Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.

    Article  PubMed  Google Scholar 

  4. Angrisani L, Santonicola A, Iovino P, et al. IFSO Worldwide Survey 2016: primary, endoluminal, and revisional procedures. Obes Surg. 2018;28:3783–94.

    Article  PubMed  Google Scholar 

  5. Silva LB, Moon RC, Teixeira AF, et al. Gastrobronchial fistula in sleeve gastrectomy and Roux-en-Y gastric bypass--a systematic review. Obes Surg. 2015;25:1959–65.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  7. Kim J, Azagury D, Eisenberg D, et al. ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management. Surg Obes Relat Dis. 2015;11:739–48.

    Article  PubMed  Google Scholar 

  8. Donatelli G, Chiche R, Cereatti F, et al. Endoscopic drainage of intra-abdominal collection after bariatric surgery. Obes Surg. 2017;27:1635–7.

    Article  PubMed  Google Scholar 

  9. Lorenzo D, Guilbaud T, Gonzalez JM, et al. Endoscopic treatment of fistulas after sleeve gastrectomy: a comparison of internal drainage versus closure. Gastrointest Endosc. 2018;87:429–37.

    Article  PubMed  Google Scholar 

  10. Baretta G, Campos J, Correia S, et al. Bariatric postoperative fistula: a life-saving endoscopic procedure. Surg Endosc. 2015;29:1714–20.

    Article  PubMed  Google Scholar 

  11. 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;22:712–20.

    Article  CAS  PubMed  Google Scholar 

  12. Parikh M, Issa R, McCrillis A, et al. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg. 2013;257:231–7.

    Article  PubMed  Google Scholar 

  13. Campos JM, Ferreira FC, Teixeira AF, et al. Septotomy and balloon dilation to treat chronic leak after sleeve gastrectomy: technical principles. Obes Surg. 2016;26:1992–3.

    Article  PubMed  Google Scholar 

  14. Rebibo L, Bartoli E, Dhahri A, et al. Persistent gastric fistula after sleeve gastrectomy: an analysis of the time between discovery and reoperation. Surg Obes Relat Dis. 2016;12:84–93.

    Article  PubMed  Google Scholar 

  15. Takahashi H, Strong AT, Guerron AD, et al. An Odyssey of complications from band, to sleeve, to bypass; definitive laparoscopic completion gastrectomy with distal esophagectomy and esophagojejunostomy for persistent leak. Surg Endosc. 2018;32:507–10.

    Article  PubMed  Google Scholar 

  16. Thompson 3rd CE, Ahmad H, Lo Menzo E, et al. Outcomes of laparoscopic proximal gastrectomy with esophagojejunal reconstruction for chronic staple line disruption after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2014;10:455–9.

    Article  PubMed  Google Scholar 

  17. Puig CA, Waked TM, Baron Sr TH, et al. The role of endoscopic stents in the management of chronic anastomotic and staple line leaks and chronic strictures after bariatric surgery. Surg Obes Relat Dis. 2014;10:613–7.

    Article  PubMed  Google Scholar 

  18. Donatelli G, Dumont JL, Cereatti F, et al. Treatment of leaks following sleeve gastrectomy by endoscopic internal drainage (EID). Obes Surg. 2015;25:1293–301.

    Article  CAS  PubMed  Google Scholar 

  19. Lainas P, Tranchart H, Gaillard M, et al. Prospective evaluation of routine early computed tomography scanner in laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2016;12:1483–90.

    Article  PubMed  Google Scholar 

  20. Fuks D, Verhaeghe P, Brehant O, et al. Results of laparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity. Surgery. 2009;145:106–13.

    Article  PubMed  Google Scholar 

  21. Spyropoulos C, Argentou MI, Petsas T, et al. Management of gastrointestinal leaks after surgery for clinically severe obesity. Surg Obes Relat Dis. 2012;8:609–15.

    Article  PubMed  Google Scholar 

  22. Sakran N, Goitein D, Raziel A, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2013;27:240–5.

    Article  PubMed  Google Scholar 

  23. Burgos AM, Braghetto I, Csendes A, et al. Gastric leak after laparoscopic-sleeve gastrectomy for obesity. Obes Surg. 2009;19:1672–7.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  25. Donatelli G, Ferretti S, Vergeau BM, et al. Endoscopic internal drainage with enteral nutrition (EDEN) for treatment of leaks following sleeve gastrectomy. Obes Surg. 2014;24:1400–7.

    Article  PubMed  Google Scholar 

  26. Chouillard E, Chahine E, Schoucair N, et al. Roux-en-Y fistulo-jejunostomy as a salvage procedure in patients with post-sleeve gastrectomy fistula. Surg Endosc. 2014;28:1954–60.

    Article  PubMed  Google Scholar 

  27. Ramos AC, Ramos MG, Campos JM, et al. Laparoscopic total gastrectomy as an alternative treatment to postsleeve chronic fistula. Surg Obes Relat Dis. 2015;11:552–6.

    Article  PubMed  Google Scholar 

  28. Yehoshua RT, Eidelman LA, Stein M, et al. Laparoscopic sleeve gastrectomy--volume and pressure assessment. Obes Surg. 2008;18:1083–8.

    Article  PubMed  Google Scholar 

  29. Donatelli G, Fuks D, Tabchouri N, et al. Seal or drain? Endoscopic management of leaks following sleeve gastrectomy. Surg Innov. 2018;25:5–6.

    Article  PubMed  Google Scholar 

  30. Rosenthal RJ, International Sleeve Gastrectomy Expert P, 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. 2012;8:8–19.

    Article  PubMed  Google Scholar 

  31. Baltasar A, Serra C, Bengochea M, et al. Use of Roux limb as remedial surgery for sleeve gastrectomy fistulas. Surg Obes Relat Dis. 2008;4:759–63.

    Article  PubMed  Google Scholar 

  32. Deitel M, Crosby RD, Gagner M. The first international consensus summit for sleeve gastrectomy (SG), New York City, October 25-27, 2007. Obes Surg. 2008;18:487–96.

    Article  PubMed  Google Scholar 

  33. Gagner M. Leaks after sleeve gastrectomy are associated with smaller bougies: prevention and treatment strategies. Surg Laparosc Endosc Percutan Tech. 2010;20:166–9.

    Article  PubMed  Google Scholar 

  34. Donatelli G, Dhumane P, Perretta S, et al. Endoscopic placement of fully covered self expanding metal stents for management of post-operative foregut leaks. J Minim Access Surg. 2012;8:118–24.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Donatelli G, Dhumane P, Vergeau BM, et al. Successful removal from the esophagus of a self-expandable metal stent that had shriveled up into a tangled ball. Endoscopy. 2013;45 Suppl 2 UCTN:E410–1.

    Article  PubMed  Google Scholar 

  36. Shehab H. Enteral stents in the management of post-bariatric surgery leaks. Surg Obes Relat Dis. 2018;14:393–403.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, Assistance Publique – Hopitaux de Paris, F-92140, Clamart, France

    Carmelisa Dammaro, Panagiotis Lainas, Hadrien Tranchart & Ibrahim Dagher

  2. Paris-Saclay University, F-91405, Orsay, France

    Carmelisa Dammaro, Panagiotis Lainas, Hadrien Tranchart & Ibrahim Dagher

  3. Department of Endoscopy, Peupliers Private Hospital, Ramsay Generale de Sante, F-75014, Paris, France

    Jean Loup Dumont & Gianfranco Donatelli

Authors
  1. Carmelisa Dammaro
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  2. Panagiotis Lainas
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  3. Jean Loup Dumont
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  4. Hadrien Tranchart
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  5. Gianfranco Donatelli
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  6. Ibrahim Dagher
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Correspondence to Panagiotis Lainas.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Carmelisa Dammaro and Panagiotis Lainas are equal first authors.

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Video 1

Endoscopic internal drainage of a perigastric cavity after initial surgical drainage of a gastric staple line leak with subsequent control endoscopy at four weeks showing complete healing and absence of contrast medium extravasation. (MP4 34,208 kb)

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Dammaro, C., Lainas, P., Dumont, J.L. et al. Endoscopic Internal Drainage Coupled to Prompt External Drainage Mobilization Is an Effective Approach for the Treatment of Complicated Cases of Sleeve Gastrectomy. OBES SURG 29, 2929–2935 (2019). https://doi.org/10.1007/s11695-019-03933-1

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