Management of anastomotic leaks after Roux-en-Y bypass using self-expanding polyester stents

Background Among the possible complications of bariatric surgery, fistula and partial dehiscence of the gastric suture are well known. Reoperation often is required but results in significant morbidity. Endoscopic treatment of some bariatric complications is feasible and efficient. Methods A modified metallic stent was placed between the gastroaesophageal junction and the alimentary jejunal limb, allowing the passage of a nasoenteric feeding tube into the jejunal limb. Results Endoscopy showed disruption of nearly the entire staple line at the gastric pouch. The modified stent was placed and allowed wound healing. After 31 days, the stent had migrated and was removed endoscopically. Total clousure of the fistula was reported 30 days afterward. Conclusions Endoscopic treatment of some bariatric surgery complications is feasible and has been reported previously. This report presents a case of a serious leakage treated by placement of a self-expandable metal stent to bridge the fistula.

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“…The disrupted remnant stomach was left to heal by second intention with the vacuum dressing (Figs. 4,5).…”

Section: Resultsmentioning

confidence: 99%

“…Some cases are associated with situations of extreme gravity, narrowing the options of treatment and thus making the complications very difficult to solve [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Extreme bariatric endoscopy: stenting to reconnect the pouch to the gastrojejunostomy after a Roux-en-Y gastric bypass

et al. 2011

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“…The use of self-expandable covered metal stents accelerates recovery time in these cases, which otherwise may be extremely long, and allows oral food intake during this period [7][8][9][10].…”

Section: Discussionmentioning

confidence: 99%

Gastroesophageal Junction Leak with Serious Sepsis after Gastric Bypass: Successful Treatment with Endoscopy-Assisted Intraluminal Esophageal Drainage and Self-expandable Covered Metal Stent

et al. 2009

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We present a case of gastroesophageal junction leak after gastric bypass with serious sepsis and hemodynamic instability. Minimally invasive treatment was performed in two stages: initial sepsis control by lavage and endoscopy-assisted laparoscopic placement of an intraluminal esophageal drainage tube through the leak orifice; this was followed by definitive leak treatment with a self-expandable covered metal stent after achieving hemodynamic stability. Patient evolution was satisfactory without the need for open surgery.

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“…The introduction of self-expandable removable stents offered a less invasive approach for management of anastomotic leak. In a retrospective study that included 5 patients with anastomotic leak and one patient with chronic gastrocutaneous fistula; self-expandable plastic stent was successful in closing the leak in all 5 patients but not in the patient with the fistula [52]. In another retrospective study that included 11 patients with acute leak and 2 patients with chronic fistula as a complication of bariatric surgery, self-expandable removal stents (metal and plastic) were successful in healing the acute leak in 89% of patients and one of the two patients with chronic fistula [53].…”

Section: Endoscopy In Treatment Of Post-surgical Leaks and Fistulasmentioning

confidence: 98%

Role of Endoscopy in Laparoscopic Procedures

Othman¹,

Patel²,

Woodward³

2011

Updated Topics in Minimally Invasive Abdominal Surgery

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Management of anastomotic leaks after Roux-en-Y bypass using self-expanding polyester stents

Cited by 44 publications

References 9 publications

Extreme bariatric endoscopy: stenting to reconnect the pouch to the gastrojejunostomy after a Roux-en-Y gastric bypass

Extreme bariatric endoscopy: stenting to reconnect the pouch to the gastrojejunostomy after a Roux-en-Y gastric bypass

Gastroesophageal Junction Leak with Serious Sepsis after Gastric Bypass: Successful Treatment with Endoscopy-Assisted Intraluminal Esophageal Drainage and Self-expandable Covered Metal Stent

Role of Endoscopy in Laparoscopic Procedures

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