Endoscopic stenting for laparoscopic sleeve gastrectomy leaks

Aydın, Mehmet Timuçin; Alahdab, Yeşim Özen; Aras, Orhan; Karıp, Bora; Onur, Ender; İşcan, Yalın; Memışoğlu, Kemal

doi:10.5152/ucd.2016.3122

Cited by 8 publications

(7 citation statements)

References 15 publications

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“…In the setting of worrisome clinical signs and normal imaging, laparoscopic or open operative exploration is warranted to rule out GI leak . Nonoperative methods of GI leak treatment after both RYGB or SG include endoscopic endoluminal self‐expandable stents, clips and sutures, endoscopic and percutaneously placed drains, and biologic glue/tissue sealants . Because length of hospital stay after bariatric surgery continues to decrease with the use of ERABS, some septic complications will occur after the relatively earlier hospital discharge .…”

Section: Executive Summarymentioning

confidence: 99%

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

Mechanick

Apovian

Brethauer

et al. 2020

Obesity

295

445

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Objective The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. Methods Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. Results New or updated topics in this CPG include: contextualization in an adiposity‐based chronic disease complications‐centric model, nuance‐based and algorithm/checklist‐assisted clinical decision‐making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). Conclusions Bariatric procedures remain a safe and effective intervention for higher‐risk patients with obesity. Clinical decision‐making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.

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Section: Executive Summarymentioning

confidence: 99%

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

Mechanick

Apovian

Brethauer

et al. 2020

Obesity

295

445

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“…In a stable patient with a proximal and mid-aspect gastric sleeve leak, the use of an endoscopic stent may be a viable option in an attempt to exclude the defect [7,15,20]. An upper endoscopy needs to be performed to assess the size and location of the leak, as well as the viability of the gastric sleeve [4].…”

Section: Discussionmentioning

confidence: 99%

“…She had an early leak, and as she had no signs of systemic sepsis, we proceeded with endoscopic covered stent placement. The use of an endoscopic covered stent is a safe and effective option in the management of staple-line leaks after sleeve gastrectomy [4,7,15,20]. However, 30 days after the operation, the possibility of the leak site healing by exclusion using a stent is low [7].…”

Section: Discussionmentioning

confidence: 99%

“…Our second patient experienced severe retrosternal pain after the stent placement, which improved with proton pump inhibitor infusion. Some authors prefer to reserve stents for use in patients who do not recover with other methods of management such as laparoscopic washout and feeding jejunostomy [10], but ultimately, proper patient selection is essential in deciding whether an endoscopic stent is suitable, as it offers an alternative to surgery [4,19,20].…”

Section: Discussionmentioning

confidence: 99%

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Staple-line leak post primary sleeve gastrectomy. A two patient case series and literature review

Loo

Rajan

Mahmood

2019

Annals of Medicine and Surgery

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There is an increasing trend in the number of bariatric surgeries performed worldwide, partly because bariatric surgery is the most effective treatment for morbid obesity. Sleeve gastrectomy (SG) remains the most common bariatric surgery procedure performed, representing more than 50% of all primary bariatric interventions. Major surgical complications of SG include staple-line bleeding, leaking, and stenosis. A leak along the staple-line most commonly occurs at the gastroesophageal junction (GOJ). From January 2018 to December 2018, our centre performed 226 bariatric procedures, of which, 97.8% were primary bariatric procedures. The mean age and BMI were 38.7±8.3 years and 44 kg/m2, respectively. Out of the 202 primary SG performed, we encountered two cases of a staple-line leak (0.99%). This is the first reported case series of SG leaks from the Southeast Asia region. A summary of their characteristics, clinical presentation, subsequent management, and the outcome is discussed. Based on the latest available evidence from the literature, several methods may decrease staple-line leaks in SG. These include the use of a bougie size greater than 40 Fr, routine use of methylene blue test during surgery, beginning transection at 2–6 cm from the pylorus, mobilising the fundus before transection, and staying away from the GOJ at the last firing. Other methods include the proper alignment of the staple-line, control of staple-line bleeding, and performing staple-line reinforcement. The management of a staple-line leak remains challenging due to limited systematic, evidence-based literature being available. Therefore, a tailored approach is needed to manage this complication.

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“…[ 6 7 8 9 ] However, only a few studies have reported the efficacy of specifically designed FC mega SEMS in the management of post-LSG leakage and stenosis. [ 10 11 12 ] Thus, the present study aimed to assess the efficacy and safety profile of using the mega stent in the management of post-LSG fistulas and stenosis in a single center. Previous studies in Saudi Arabia have only reported the use of partially covered SEMS in the management of post-LSG leak.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Management of Post-Laparoscopic Sleeve Gastrectomy Leakage and Stenosis Using Fully Covered Stent

Aljahdli

AlDabbagh

Salah

et al. 2021

Saudi J Med Med Sci

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Background: Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed surgery to treat morbid obesity. Post-LSG leak and stenosis are serious complications that can be associated with significant morbidity and mortality. Objective: The objective was to report the efficacy and safety profile of using specifically designed fully covered self-expandable metallic stent for the treatment of post-LSG complications. Methods: This retrospective study included adult patients who underwent placement of a fully covered esophagogastric, self-expandable metallic stent for post-LSG leak or stenosis. The procedure was carried out at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between September 2017 and May 2019. Data regarding demographics, indication for stenting, size of the stent, procedural success and poststenting adverse events were collected. Results: A total of 14 patients met the inclusion criteria, with indication for endoscopic stenting being post-LSG leak in 11 patients and stenosis in 3 patients. The technical success rate of self-expandable metallic stent placement was 100%, and the clinical success was 85.7% (12 of 14 patients). Nausea (71.4%) and vomiting (85.7%) were the most frequent mild adverse events reported. Stent-induced esophageal stricture was the only major adverse event reported in two patients. Conclusion: Placement of specifically designed self-expandable metallic stent for the treatment of post-LSG leak and stenosis is an effective and safe approach. Further studies with larger cohorts are needed to assess the optimal duration needed to treat such complications.

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Endoscopic stenting for laparoscopic sleeve gastrectomy leaks

Cited by 8 publications

References 15 publications

Staple-line leak post primary sleeve gastrectomy. A two patient case series and literature review

Endoscopic Management of Post-Laparoscopic Sleeve Gastrectomy Leakage and Stenosis Using Fully Covered Stent

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