Stent treatment for fistula after obesity surgery: results in 47 consecutive patients

Abstract

Leaks after bariatric surgery can be treated safely and effectively by endoscopic stents. In cases of persisting leaks, laparoscopic intervention is successful in a majority of cases. Late strictures seldom occur.

A novel fully covered double-bump stent for staple line leaks after bariatric surgery: a retrospective analysis

“…This seems comparable to the results of other fully covered stents, with a migration rate of 18–67% in previous studies [8, 11, 16, 17, 19, 20]. Partially covered stents are less prone to migration with a migration rate of 5–15% [7, 10, 14, 15, 18]. However, these stents are often difficult to remove [7].…”

“…In addition, there are differences in indication, definition of success and stent type between studies. For example, in the study describing the highest success rate (96%), a partially covered metal stent was placed in all patients with staple line leakage, including small leaks that might also have closed with conservative management only [15]. The definition of success in our study was stricter than in some other studies.…”

“…In group 1, the success rate was 100%, compared to 55% success rate in group 2. This result raises the question whether immediate stent placement should be considered in all patients with staple line leakage [15]. However, it must be underlined that the difference between the two groups in this study is subject to considerable bias.…”

ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management

“…Stenting may allow the patient to support their own nutritional needs with oral feeding during the healing process, potentially decreasing the overall duration of treatment [59]. The majority of patients treated with an endoluminal stent achieve complete healing with a success rate of 55-100% [58][59][60]63,83,98,[100][101][102][103][104][105][106][107][108][109][110][111][112]. Stenting often requires multiple endoscopies for stent replacement, or for the addition of other endoscopic adjuncts, over the course of treatment [59,101,106,108,113].…”

Endoscopic management of bariatric surgical complications

“…A novel approach using a cardiac septal occluder device (Amplatzer; St. Jude Medical, Plymouth, Minnesota, USA) has been described in a patient with a post sleeve gastrectomy leak and may be a suitable last resort in patients that fail other endoscopic attempts at closure [45]. Diversion therapy using esophageal SEMS achieves clinical success in 55-100% of patients, although multiple endoscopic sessions using multiple stents as well as other adjunctive therapies may be necessary [14,29,[46][47][48][49]. Optimal results are noted when esophageal SEMS are utilized for acute and early leaks with clinical response in more than 90% of patients ( Fig.…”