Successful Endoscopic Management of Gastrointestinal Leakages after Laparoscopic Roux-en-Y Gastric Bypass Surgery

Abstract

Background: Management of leakages of the gastrojejunal anastomosis after laparoscopic Roux-en-Y gastric bypass (LRYGB) can be complex. New endoscopic techniques such as covered stents and over-the-scope clips (OTCs) have been developed and are valuable alternative therapeutic options to reoperation and drainage. The aim of this study was to compare the value of stents and OTCs with surgical treatment options for the therapy of anastomotic leakages after LRYGB. Methods: Results of patients who were treated surgically with reoperation, local irrigation and drain placement (n = 9) were compared with results of patients who were treated endoscopically with stent and/or OTC placement (n = 5). Success rate, length of hospital stay, mortality, number of OTC applications/stent placement and percutaneous drainage placements were analyzed. Results: Overall, 14 of 1,046 patients (1.34%) developed a leakage of their gastrojejunal anastomosis after LRYGB between 2000 and 2012. While the success rate in surgically treated patients was 88%, the endoscopic treatment using a sequential approach with stenting, OTC application and percutaneous placement of drainages resulted in a 100% closure rate. The mortality rate and length of stay were not substantially different after both treatment regimens. Conclusion: Endoscopic management of anastomotic leakages after LRYGB may constitute a valuable alternative therapeutic option to surgical reoperation and drainage placement.

Presentation and surgical management of leaks after mini–gastric bypass for morbid obesity

“…However UGI series are reported to have a low sensitivity because they detect a leak only in the 20% of patients [33,34]. In our series UGI [27,35,40,41]. In our limited experience endoluminal stenting for post-MGB leakage does not seem to be recommended because of the risk of migration into the gastro-jejunostomy that could lead to obstruction or perforation.…”

Endoscopic management of leaks and fistulas after bariatric surgery: a systematic review and meta-analysis

“…In addition, we presented the data regarding OTSC therapy from the study describing the use of endoscopic closing techniques alone versus endoscopic drainage (with or without other endoscopic techniques) [72]. We excluded from our analysis studies or study results reporting the concomitant use of stent or stent placement before clipping (Supplementary material, Figure S9) [40,66,70,72,75,77,78,[81][82][83][84][85][86][87][88][89][90][91]. Different definitions of therapy success were applied in the reviewed studies.…”

Early and late complications after gastric bypass: A literature review

“…Some researchers consider weight gain as the difference between the highest and lowest body weight after surgery; increase in Body Mass Index; % EWL = lost body weight (kg) : overweight (kg) • 100, or the difference between the weight before and after the operation expressed as a percentage [5,75,47]. Weight gain occurs in about 20 % of patients after laparoscopic RYGB [65,22,51]. In the study, weight gain of more than 10 % of the lowest body weight in the postoperative period was recorded in 24 % of patients [75].…”