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Background: Sleeve gastrectomy has become a valuable and effective option in the treatment of morbid obesity. Although a safe procedure overall, the operation does have a significant potential complication in the form of staple line leak. One of the strategies described to treat this complication is the placement of esophageal stents. We describe our experience with the placement of covered esophageal stents as a first-line treatment of staple line leakage after sleeve gastrectomy. Methods: A retrospective review of all patients undergoing sleeve gastrectomy at our institution from 28th June 2004 to 31st Oct 2011 was performed. Patients presenting with staple line leak were identified. Also included were patients transferred from outside institutions with this diagnosis. In all cases, the leak was treated with esophageal stent placement. Outcomes of interest included rate of resolution, body mass index (BMI) and time at presentation. Results: Four patients were identified with a diagnosis of staple line leak after laparoscopic sleeve gastrectomy. Time at presentation was 35 ± 47.7 weeks postoperatively. BMI was 45 ± 2.25. In all cases, the leak was successfully managed with endoscopic placement of covered esophageal stent. In two cases, the patients required multiple stent placements. Conclusion: Staple line leaks after sleeve gastrectomy can be successfully and safely managed with endoscopic placement of covered metal stents. Stenting should be considered as firstline treatment of these complications. Optimal duration of stent therapy is 6 to 8 weeks although repeat stent placement may be required.

Background: Sleeve gastrectomy has become a valuable and effective option in the treatment of morbid obesity. Although a safe procedure overall, the operation does have a significant potential complication in the form of staple line leak. One of the strategies described to treat this complication is the placement of esophageal stents. We describe our experience with the placement of covered esophageal stents as a first -line treatment of staple line leakage after sleeve gastrectomy. Methods:A retrospective review of all patients undergoing sleeve gastrectomy at our institution from 28th June 2004 to 31st Oct 2011 was performed. Patients presenting with staple line leak were identified. Also included were patients transferred from outside institutions with this diagnosis. In all cases, the leak was treated with esophageal stent placement. Outcomes of interest included rate of resolution, body mass index (BMI) and time at presentation.Results: Four patients were identified with a diagnosis of staple line leak after laparoscopic sleeve gastrectomy. Time at presentation was 35 ± 47.7 weeks postoperatively. BMI was 45 ± 2.25. In all cases, the leak was successfully managed with endoscopic placement of covered esophageal stent. In two cases, the patients required multiple stent placements. Conclusion:Staple line leaks after sleeve gastrectomy can be successfully and safely managed with endoscopic placement of covered metal stents. Stenting should be considered as firstline treatment of these complications. Optimal duration of stent therapy is 6 to 8 weeks although repeat stent placement may be required.

SummaryExposure to the fungal pathogen Coccidioides immitis in normal hosts causes primarily self-limited pulmonary disease. We report a case of an immunocompetent patient who developed a Coccidioides-associated iliopsoas abscess with rare intra-abdominal dissemination at least one decade after primary exposure in an area endemic for this fungus. BACKGROUND

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