Endoscopic treatment of early leaks and strictures after laparoscopic one anastomosis gastric bypass

Abstract

Background: Laparoscopic one anastomosis gastric bypass has become a prominent bariatric procedure. Yet, early and late complications, primarily leaks and strictures, are not uncommon. This study summarizes our experience with endoscopic treatment of laparoscopic one anastomosis gastric bypass complications. Methods: This is a retrospective study of consecutive patients referred to our hospital from 2015 to 2017 with post laparoscopic one anastomosis gastric bypass complications. Therapy was tailored to each case, including fully covered self-expandable metal stents, fibrin glue, septotomy, internal drainage with pigtail stents, through-thescope and pneumatic dilation. Success was defined as resuming oral nutrition without enteral or parenteral support or further surgical intervention. Results: Nine patients presented with acute or early leaks: 5 (56%) had staple-line leaks, 3 (33%) had anastomotic leaks and 1 (11%) had both. All were treated with stents. Adjunctive endoscopic drainage was applied in 4 patients (44%). Overall 5 patients (56%) with acute/ early leaks recovered completely, including all 3 patients with anastomotic leak and the patient with both leaks but only 1/5 with staple line leak (20%). Complication rate in the leak group reached 22%. Eight patients presented with strictures, 7 at the anastomosis and one due to remnant stomach misalignment. All anastomotic strictures were dilated successfully. However, the patient with the pouch stricture required conversion to Roux-en-Y gastric bypass after 3 failed attempts of dilation. Conclusion: Endoscopic treatments of laparoscopic one anastomosis gastric bypass complications are relatively effective and safe. Anastomosis-related complications are more amenable to endoscopic treatment compared to staple line leaks.

Management of leaks following one-anastomosis gastric bypass: an updated systematic review and meta-analysis of 44 318 patients

“… 8 and Younis et al . 16 , were deleted from leak prevalence analysis because they reported leak as a reason for revision surgery and endoscopic management among their revision and endoscopic procedures, not amongst all revisional OAGB patients.…”

“…All patients with anastomotic leaks had a favorable outcome, whereas this treatment succeeded in only one patient with a staple line leak. Despite this attitude, two patients developed a late fistula needing additional drainage procedures (including pigtail), and another patient had an emergency laparotomy due to a stent migration with perforation of the ileum 16 . Endoscopy can also be a second-line treatment, as was described by Beaupel et al .…”

Systematic treatment of giant gastroduodenal anastomotic leakage: a case report

“…The incidence of distal gastrectomy anastomotic leakage is currently reported to be 2.1% [8], and the incidence of anastomotic leakage for Bi1-style anastomosis using a circular anastomosis is 0-2.4% [9]. The current treatment of post-gastrectomy anastomotic leakage and duodenal stump leakage mainly includes conservative treatment, various endoscopic treatments and surgical treatment [10][11][12][13][14][15][16][17][18]. However, there is no scienti c literature on the treatment of gastroduodenal anastomotic leakage, which is more complex and has a higher mortality rate than duodenal stump leakage.…”

Anastomotic leak test using indocyanine green during laparoscopic Roux-en-Y gastric bypass: A cohort study

“…Morbid obesity has become a major global health threat that leads to severe morbidity including diabetes, hypertension, obstructive sleep apnea, degenerative joint dis-ease and cardiovascular diseases [ 1 ].…”