Endoscopic Insertion Of A Self-Expandable Stent Combined With Laparoscopic Rinsing Of Peritoneal Cavity As A Method For Staple Line Leaks Treatment In Patients Post Laparoscopic Sleeve Gastrectomy

• Authors: Maciej Matłok , Piotr Major , Michał Pędziwiatr , Marek Winiarski , Piotr Budzyński , Piotr Małczak , Leif Hynnekleiv , Andrzej Budzyński
• Languages of publication: EN

Abstracts

EN

Currently, laparoscopic sleeve gastrectomy is one of bariatric surgeries most commonly performed in the world. The most frequent complications of surgeries of this type, with the highest mortality rate, include bleeding into the GI tract and peritoneal cavity, and sleeve staple line leaks. These severe complications prolong the hospital stay, and often are a cause of patient’s death. While in a case of bleeding the procedure appears to be obvious, so far no uniform and standard guidelines have been established for the group of patients with staple line leaks.The aim of the study was to report results of treatment for staple line leaks following laparoscopic sleeve gastrectomy with a laparoscopic procedure and simultaneous endoscopic insertion of a self-expandable stent.Material and methods. 152 laparoscopic sleeve gastrectomies were performed from April 2009 to December 2014. The BMI median was 46.9, and the age median was 42 years. Staple line leaks developed in 3 out of 152 people (1.97%). All patients who developed this complication were included in the study. The treatment involved laparoscopic revision surgery with simultaneous endoscopic insertion of a self-expandable stent (Boston Scientific, Wallflex Easophageal Stent, 150×23 mm) into the gastric stump during gastroscopy.Results. Leaks following laparoscopic sleeve gastrectomy were diagnosed on day 5 after the procedure, on average. Intervention consisting of laparoscopy and endoscopic insertion of a self-expandable stent was initiated within 14 hours of diagnosing the leak, on average. The mean time for which the stent was kept was 5 weeks (4–6 weeks). Stenting proved to be fully effective in all patients, where after discharging home, a cutaneous fistula, periodically (every 2-3 weeks) discharging several millilitres of matter, persisted in one patient. The mean time for the leak healing in 2 patients, in whom the described method was successful in treatment of this complication, was 37 days. No patient died in the perioperative or follow-up period.Conclusions. The proposed method for treatment of staple line leaks following laparoscopic sleeve gastrectomy by combined laparoscopic rinsing and draining of the peritoneal cavity and endoscopic insertion of a self-expandable stent is an interesting and worth recommending method for treatment of this complication.

Keywords

EN

bariatric surgery; laparoscopic sleeve gastrectomy; post-bariatric surgery complications; staple line leaks

• Publisher: De Gruyter Open
• Journal: Polish Journal of Surgery
• Year: 2015
• Volume: 87
• Issue: 5
• Pages: 238-244

Dates

published

1 - 5 - 2015

online

10 - 7 - 2015

received

23 - 2 - 2015

Contributors

author

Maciej Matłok

• 2 Department of General SurgeryKierownik: prof. dr hab.

author

Piotr Major

• 2 Department of General SurgeryKierownik: prof. dr hab.

author

Michał Pędziwiatr

• 2 Department of General SurgeryKierownik: prof. dr hab.

author

Marek Winiarski

• 2 Department of General SurgeryKierownik: prof. dr hab.

author

Piotr Budzyński

• 2 Department of General SurgeryKierownik: prof. dr hab.

author

Piotr Małczak

• Students’ Society of Science 2 Department of General SurgeryOpiekunowie Koła: dr n. med. , dr n. med. , dr n. med. Jagiellonian University Collegium Medicum in Cracow

author

Leif Hynnekleiv

• Students’ Society of Science 2 Department of General SurgeryOpiekunowie Koła: dr n. med. , dr n. med. , dr n. med. Jagiellonian University Collegium Medicum in Cracow

author

Andrzej Budzyński

• 2 Department of General SurgeryKierownik: prof. dr hab.

References

• 1. Welbourn R, Gagner M, Otosson J et al.: IFSO Global Registry Report 2014, Dendrite Clinical Systems Ltd.
• 2. Fuks D, Verhaeghe P, Brehant O et al.: Results of laparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity. Surgery Elsevier 2009; 145: 106-13.
• 3. Himpens J, Dobbeleir J, Peeters G: Long-term results of laparoscopic sleeve gastrectomy for obesity. Annals of Sur 2010; 252(2): 319-24.
• 4. Lalor PF, Tucker ON, Szomstein S: Complications after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2008; 4: 33-38.
• 5. Aurora AR, Khaitan L, Saber AA : Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surgical Endoscopy. Springer-Verlag 2011; 26: 1509-15.
• 6. Eisendrath P, Cremer M, Himpens J: Endotherapy including temporary stenting of fistulas of the upper gastrointestinal tract after laparoscopic bariatric surgery. 2007; 39(7): 625-30.
• 7. Csendes A, Braghetto I, León P et al.: Management of leaks after laparoscopic sleeve gastrectomy in patients with obesity. J of Gastrointestinal Surg Springer-Verlag; 2010; 14: 1343-48.
• 8. Casella G, Soricelli E, Rizzello M et al.: Nonsurgical treatment of staple line leaks after laparoscopic sleeve gastrectomy. Obesity surgery. Springer-Verlag; 2009; 19: 821-26.
• 9. Salinas A, Baptista A, Santiago E et al.: Self-expandable metal stents to treat gastric leaks. Surg Obes Relat Dis 2006; 2(5): 570-02.
• 10. 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): 931-36.
• 11. Eubanks S, Edwards CA, Fearing NM: Use of endoscopic stents to treat anastomotic complications after bariatric surgery. JAM Coll Surg 2008; 206(5): 935-38.
• 12. Puli SR, Spofford IS, Thompson CC : Use of self-expandable stents in the treatment of bariatric surgery leaks: a systematic review and meta-analysis. Gastrointestinal Endoscopy 2012; 75(2): 287-93.
• 13. Simon F, Siciliano I, Gillet A et al.: Gastric leak after laparoscopic sleeve gastrectomy: early covered self-expandable stent reduces healing time. Obesity surgery. Springer-Verlag; 2013; 23: 687-92.
• 14. 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? Obesity surgery. Springer-Verlag; 2012; 22: 712-20.
• 15. de Aretxabala X, Leon J, Wiedmaier G et al.: Gastric leak after sleeve gastrectomy: analysis of its management. Obesity surgery. Springer-Verlag; 2011; 21: 1232-37.
• 16. Oshiro T, Kasama K, Umezawa A et al.: Successful Management of Refractory Staple Line Leakage at the Esophagogastric Junction After a Sleeve Gastrectomy Using the HANAROSTENT. Obesity Surg. Springer-Verlag; 2009; 20: 530-34.
• 17. Oshiro T, Kasama K, Umezawa A et al.: Successful management of refractory staple line leakage at the esophagogastric junction after a sleeve gastrectomy using the HANAROSTENT. Obesity Surg 2010; 20(4): 530-34.

Identifiers

DOI

10.1515/pjs-2015-0048