Endoscopic internal drainage for the management of leak, fistula, and collection after sleeve gastrectomy: our experience in 617 consecutive patients

Donatelli, Gianfranco; Spota, Andrea; Cereatti, Fabrizio; Granieri, Stefano; Dagher, Ibrahim; Chiche, R; Catheline, Jean-Marc; Pourcher, Guillaume; Rebibo, Lionel; Calabrese, Daniela; Msika, Simon; Dammaro, Carmelisa; Tranchart, Hadrien; Laïnas, Panagiotis; Tuszynski, Thierry; Pacini, Filippo; Arienzo, Roberto; Chevallier, Jean‐Marc; Trelles, Nelson; Lazzati, Andrea; Paolino, Luca; Papini, Federica; Torcivia, Adriana; Genser, Laurent; Arapis, Kostas; Soprani, Antoine; Randone, Bruto; Chosidow, Denis; Bouillot, Jean‐Luc; Marmuse, Jean–Pierre; Dumont, Jean-Loup

doi:10.1016/j.soard.2021.03.013

Cited by 39 publications

(21 citation statements)

References 37 publications

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“…These stents, typically used for biliopancreatic indications, are hard, less flexible, and can potentially cause tissue trauma leading to undesirable adverse events (AEs) such as the two events of mucosal erosion and tracheoesophageal fistula reported by the authors. Additionally, despite not being reported in this series, bleeding and aneurism can also occur 4 .…”

Section: To the Editormentioning

confidence: 63%

Does it matter which plastic stents we use for the treatment of post-surgical leaks? Or is it a one-size-fits-all?

Sánchez-Luna¹,

Moura²,

Medeiros³

2021

Rev Esp Enferm Dig

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Section: To the Editormentioning

confidence: 63%

Does it matter which plastic stents we use for the treatment of post-surgical leaks? Or is it a one-size-fits-all?

Sánchez-Luna¹,

Moura²,

Medeiros³

2021

Rev Esp Enferm Dig

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“…Endoscopic therapy is often effective (70 %-80 %) for closure of acute perforations and leakages [3,17]; however, results are disappointing in cases of chronic fistulas, with less than 50 % of fistulas achieving long-term healing [6,7,9,18,19].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic submucosal dissection combined with clip for closure of gastrointestinal fistulas including those refractory to previous therapy

et al. 2021

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Objective: Gastrointestinal (GI) fistula, a life-threatening condition, represents a therapeutic challenge. Rescue surgery could be hazardous and/or impact quality of life justifying endoscopic con-servative approach including mucosal abrasion, clip closure or stent diversion with moderate success rates in the long term. We assessed whether Fistulas Endoscopic Submucosal Dissection with clip Closure (FESDC) could lead to complete resolution of fistulas even if previous endoscopic therapy failed. Results: 23 patients with GI fistulas were retrospectively included, 57% of those were defined as refractory fistulas since previous endoscopic treatment failed. Tight immediate sealing was obtained for 19 patients (83% [95% CI: 61%, 95%]) who received FESDC. Long term closure (>3 months) was obtained in 14 cases (61% [95% CI: 39%, 80%]) with a median follow-up of 20 months. Ad-verse events occurred in 9% of cases. Previous local malignancy (p=0.077) or radiation therapy (p=0.047) were associated with a higher risk of failure. Conclusion: The new FESDC strategy is safe and allows permanent endoscopic closure of GI fistulas in 61% of the patients, and 54% of those with previous attempt. Further studies are war-ranted to determine the place of this technic in the management of chronic GI fistula.

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“…The abdominal focus must be additionally drained radiologically or surgically. The drainage of secretions through an internal drainage by implantation of a double-pigtail-drainage to endoluminal can lead to a successful healing of the insufficiency in up to 78% according to the study results [ 6 , 7 ]. One of the reasons for the better outcome of patients in Group B is caused by the included patients without intra-abdominal abscesses in this group.…”

Section: Discussionmentioning

confidence: 99%

“…This surgical intervention is easy to implement, as it does not contain any anastomose. Surgical complications after sleeve gastrectomy remain challenging, especially the management of staple line leaks (SLL), which occur in up to 2% of LSG patients [ 7 ]. Early diagnosis of SSL is relevant for the further clinical course of the disease, but obese patients do not present the typical peritonitis picture [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Role of Rendezvous-Procedure in the Treatment of Complications after Laparoscopic Sleeve Gastrectomy

Wichmann¹,

Scheble

Fusco

et al. 2021

JCM

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Introduction: Laparoscopic sleeve gastrectomy is one of the most commonly performed bariatric procedures worldwide with good results, high patient acceptance, and low complication rates. The most relevant perioperative complication is the staple line leak. For the treatment of this complication, endoscopic negative pressure therapy has proven particularly effective. The correct time to start endoscopic negative pressure therapy has not been the subject of studies to date. Methods: Twelve patients were included in this retrospective data analysis over three years. Endoscopic negative pressure therapy was carried out using innovative open pore suction devices. Patients were treated with simultaneous surgery and endoscopy, so called rendezvous-procedure (Group A) or solely endoscopically, or in sequence surgically and endoscopically (Group B). Therapy data of the procedures and outcome measures, including duration of therapy, therapy success, and change of treatment strategy, were collected and analysed. Results: In each group, six patients were treated (mean age 52.96 years, 4 males, 8 females). Poor initial clinical situation, time span of endoscopic negative pressure therapy (Group A 31 days vs. Group B 18 days), and mean length of hospital stay (Group A 39.5 days vs. Group B 20.17 days) were higher in patients with rendezvous procedures. One patient in Group B died during the observation time. Discussion: Rendezvous procedures for patients with staple line leaks after sleeve gastrectomy is indicated for serious ill patients with perigastric abscesses and in need of laparoscopic lavage. The one-stage complication management with the rendezvous procedure seems not to result in an obvious advantage in the further outcome in patients with staple line leaks after laparoscopic sleeve gastrectomy.

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Endoscopic internal drainage for the management of leak, fistula, and collection after sleeve gastrectomy: our experience in 617 consecutive patients

Cited by 39 publications

References 37 publications

Does it matter which plastic stents we use for the treatment of post-surgical leaks? Or is it a one-size-fits-all?

Does it matter which plastic stents we use for the treatment of post-surgical leaks? Or is it a one-size-fits-all?

Endoscopic submucosal dissection combined with clip for closure of gastrointestinal fistulas including those refractory to previous therapy

Role of Rendezvous-Procedure in the Treatment of Complications after Laparoscopic Sleeve Gastrectomy

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