ObjectivesTo retrospectively evaluate the effectiveness of gastroesophageal stenting for post sleeve gastrectomy staple line leaks using removable self-expandable stents.MethodsBetween April 2012 and June 2015, 12 consecutive patients (6 males) with mean age of 34 years: (21-38 years) presented with staple line leak 1-8 weeks after the operation (mean 2.8 weeks). Patients underwent gastroesophageal stenting by interventional radiology. A total of 23 stents were deployed with mean length of 17.8 cm (7-24 cm) and mean diameter 25.6 mm (18-36 mm). Stent re-insertion was needed in 7 patients (9 procedure), while 6 patients required percutaneous collection drainage and 3 patients required endoscopic glue injection with clipping. Two stent removal procedures were carried out under endoscopic visualization after failed stent capture under fluoroscopy, while the remaining stents were successfully removed by interventional radiology.ResultsStent placement was technically successful in all patients. Stent migration occurred in 6 patients (50%). There is a tendency for stent migration with shorter stent length (R= -0.557, p=0.008). The mean duration of stenting was 60.5 days (14-137 days). All patients underwent stent removal and resumed oral intake with no recurrence of leak at a mean follow up time of 190 days (14-410 days). Complications included gastrointestinal bleeding (n=1), proximal esophageal stricture (n=1) and stent occlusion (n=1).ConclusionGastroesophageal stenting as a primary measure after diagnosis of early post sleeve gastrectomy leak appears to offer a safe and effective alternative option in obviating repeat surgical interventions. Minimally invasive interventions may still be required for the management of persistent leak.
Fallopian tube disease is a major cause of infertility. Hysterosalpinogram and selective salpingography may reveal the underlying pathology. Fallopian tubes recanalization or embolization may help improving the pregnancy rate in cases of tubes obstruction or hydrosalpinx, respectively. Fallopian Tube Recanalization: Obstruction of the uterine (proximal) segment of the fallopian tube can be seen in 10-20% of hysterosalpingograms and has a variety of underlying causes. Selective salpingography and fallopian tube recanalization may improve pregnancy rate by 15-60% within one year. Fallopian Tubes Embolization: Hydrosalpinx accounts for 10-30% of tubal pathologies in patients with secondary infertility, and it may affect the outcome of in vitro fertilization by reducing the probability of implantation and by increasing the risk of early pregnancy loss. While tubal embolization may not increase the rate of pregnancy, it may reduce the risk of abortion.
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