Endoscopic management of acute leak after sleeve gastrectomy: principles and techniques

Júnior, João Remí de Freitas; Souza, Gabriel Mayo Vieira de; Oliveira, Guilherme Henrique Peixoto de; McCarty, Thomas R.; Thompson, Christopher C.; Moura, Eduardo Guimarães Hourneaux de

doi:10.1055/a-1525-1661

Cited by 8 publications

(4 citation statements)

References 5 publications

(5 reference statements)

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“…Different from several studies, 5,8,14,28 we reported the use of adjunctive endoscopic approaches in a substantial part of our population. This finding is related to our experience in treating these challenging conditions, as described in Methods 27,29–34 . It is important to state that there is no gold standard method to treat TGID.…”

Section: Discussionmentioning

confidence: 64%

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Homemade endoscopic vacuum therapy device for the management of transmural gastrointestinal defects

Hirsch

McCarty

Santos

et al. 2023

Digestive Endoscopy

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ObjectivesEndoscopic vacuum therapy (EVT) possesses a unique mechanism of action providing a less invasive alternative for the management of transmural gastrointestinal defects (TGID). This study evaluates the efficacy and safety of a novel homemade EVT (H‐EVT) for the treatment of TGID.MethodsRetrospective multicenter study including patients who underwent H‐EVT for TGID between January 2019 and January 2022. Main outcomes included technical and clinical success as well as safety outcomes. Subgroup analyses were included by defect location and classification. Logistic regression analyses were performed to determine predictors for successful closure.ResultsA total of 144 patients were included. Technical success was achieved in all patients, with clinical success achieved in 88.89% after a mean of 3.49 H‐EVT exchanges over an average of 23.51 days. After excluding 10 cases wherein it was not possible to achieve negative pressure, successful closure occurred in 95.52% of patients. Time to clinical success was less for defects caused by endoscopic (hazard ratio [HR] 0.63; 95% confidence interval [CI] 0.33–1.20) compared to surgical procedures and for patients with simultaneous intracavitary and intraluminal H‐EVT placement (HR 0.70; 95% CI 0.55–0.91). Location and classification of defect did not impact clinical success rate. Simultaneous placement of both an intraluminal and intracavitary H‐EVT (odds ratio 3.08; 95% CI 1.19–7.95) was a significant predictor of clinical success. Three device‐related adverse events (2.08%) occurred.ConclusionsThe use of the H‐EVT is feasible, safe, and effective for the management of TGID.

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Section: Discussionmentioning

confidence: 64%

“…This finding is related to our experience in treating these challenging conditions, as described in Methods. 27,[29][30][31][32][33][34] It is important to state that there is no gold standard method to treat TGID. An individualized approach considering personal/local experience is required.…”

Section: Discussionmentioning

confidence: 99%

Homemade endoscopic vacuum therapy device for the management of transmural gastrointestinal defects

Hirsch

McCarty

Santos

et al. 2023

Digestive Endoscopy

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“…An alternative closure of leakage after bariatric surgery can be successfully performed with OTSC as first or second line therapy with good results up to closure rates of 86.3% [ 11 , 12 ]. The most frequently performed endoscopic therapy for leakages after bariatric surgery worldwide is the stent therapy [ 1 , 13 , 14 ]. A challenge is the stent fixation in bariatric patients.…”

Section: Discussionmentioning

confidence: 99%

“…A drainage wrapped by an open-pore suction device (OPSD) is placed endoluminal in position of the leak or intracavitary. Via the drain a negative pressure is applied and causes wound cleansing, defect closure and tissue granulation [ 13 ]. OPSD are used as either a polyurethane sponge connected to a drain—a so called open-pore polyurethane foam drainage (OPD), or as a thin open-pore double-layered drainage film (OFD), which is hand-wrapped around a gastric tube14.…”

Section: Introductionmentioning

confidence: 99%

Role of Rendezvous-Procedure in the Treatment of Complications after Laparoscopic Sleeve Gastrectomy

Wichmann¹,

Scheble

Fusco

et al. 2021

JCM

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Introduction: Laparoscopic sleeve gastrectomy is one of the most commonly performed bariatric procedures worldwide with good results, high patient acceptance, and low complication rates. The most relevant perioperative complication is the staple line leak. For the treatment of this complication, endoscopic negative pressure therapy has proven particularly effective. The correct time to start endoscopic negative pressure therapy has not been the subject of studies to date. Methods: Twelve patients were included in this retrospective data analysis over three years. Endoscopic negative pressure therapy was carried out using innovative open pore suction devices. Patients were treated with simultaneous surgery and endoscopy, so called rendezvous-procedure (Group A) or solely endoscopically, or in sequence surgically and endoscopically (Group B). Therapy data of the procedures and outcome measures, including duration of therapy, therapy success, and change of treatment strategy, were collected and analysed. Results: In each group, six patients were treated (mean age 52.96 years, 4 males, 8 females). Poor initial clinical situation, time span of endoscopic negative pressure therapy (Group A 31 days vs. Group B 18 days), and mean length of hospital stay (Group A 39.5 days vs. Group B 20.17 days) were higher in patients with rendezvous procedures. One patient in Group B died during the observation time. Discussion: Rendezvous procedures for patients with staple line leaks after sleeve gastrectomy is indicated for serious ill patients with perigastric abscesses and in need of laparoscopic lavage. The one-stage complication management with the rendezvous procedure seems not to result in an obvious advantage in the further outcome in patients with staple line leaks after laparoscopic sleeve gastrectomy.

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Multiple Endoscopic Therapies for Treatment of Chronic Post-bariatric Surgery Gastropleural Fistula

et al. 2022

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Endoscopic management of acute leak after sleeve gastrectomy: principles and techniques

Cited by 8 publications

References 5 publications

Homemade endoscopic vacuum therapy device for the management of transmural gastrointestinal defects

Homemade endoscopic vacuum therapy device for the management of transmural gastrointestinal defects

Role of Rendezvous-Procedure in the Treatment of Complications after Laparoscopic Sleeve Gastrectomy

Multiple Endoscopic Therapies for Treatment of Chronic Post-bariatric Surgery Gastropleural Fistula

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