Endoscopic management of a gastric leak after laparoscopic sleeve gastrectomy using the over-the-scope-clip (Ovesco®) system

Caballero, Yurena; López-Tomassetti, Eudaldo; Castellot, Ana; Hernández, Juan Ramón Hernández

doi:10.17235/reed.2016.3901/2015

Cited by 7 publications

(2 citation statements)

References 17 publications

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“…Esophageal self-expanding metal stent implantation is another well-established method either on its own or complementing other procedures, with or without percutaneous glue [10–12]. Gastroscopic implantation of the Over-The-Scope Ovesco clip at the fistula orifice is somewhere on the borderline between the conservative and surgical approaches [13]. Another option is the rendezvous technique of inserting a pigtail catheter or a nasobiliary tube into the abscess cavity through the fistula, draining the abdominal cavity as well as the stomach [14].…”

Section: Discussionmentioning

confidence: 99%

Staple line leak with peritonitis after laparoscopic sleeve gastrectomy - a solution in one to six steps.

Špička¹

2017

Videosurgery and Other Miniinvasive Techniques

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IntroductionLaparoscopic sleeve gastrectomy (LSG) is one of the most efficient bariatric interventions in morbidly obese patients. The most severe risk of this procedure seems to be the staple line leak, and the management of this complication can be very arduous.AimTo share our experience in managing the staple line leak after LSG and to help to find the best procedure that should be preferred.Material and methodsIn the 2010–2015 period we performed 223 LSG, with about 5 demonstrating severe complications – two patients with severe bleeding requiring revision surgery, and three patients with resection surface leak.ResultsWe always primarily treated the staple line leak with a laparoscopic revision. Once the fistula did not spontaneously close after this treatment. A series of other methods were then indicated for this patient and only the sixth one resulted in the desirable therapeutic success. At first, our team opted for laparoscopic revision with drainage. The next procedure involved applying Ovesco and Boston clips. As a third method we performed abscess drainage through a nasobiliary tube inserted via gastroscopy. Due to failure we performed the second laparoscopic revision with staple line resuture, the next intervention was an open revision with fistula excision and suture, and finally we opted for the application of a self-expanding metallic stent, which proved to be definitely curative.ConclusionsWithout any guidelines it is very difficult to determine the right procedure addressing the staple line leak after LSG. It depends mainly on the clinician’s experience and is lengthy and often untraditional.

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Section: Discussionmentioning

confidence: 99%

Staple line leak with peritonitis after laparoscopic sleeve gastrectomy - a solution in one to six steps.

Špička¹

2017

Videosurgery and Other Miniinvasive Techniques

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“…Post-closure follow-up ranged from 14 days to 46 months (Table 3). Three case reports provided information about follow-up body weight and reported weight loss in two patients and stable body mass in one patient [64][65][66].…”

Section: Clipping Techniquesmentioning

confidence: 99%

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

et al. 2020

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Background Endoscopic techniques have become the first-line therapy in bariatric surgery-related complications such as leaks and fistulas. We performed a systematic review and meta-analysis on the effectiveness of self-expandable stents, clipping, and tissue sealants in closing of post-bariatric surgery leak/fistula. Methods A systematic literature search of the Medline/Scopus databases was performed to identify full-text articles published up to February 2019 on the use of self-expandable stents, clipping, or tissue sealants as primary endoscopic strategies used for leak/fistula closure. Meta-analysis of studies reporting stents was performed with the PRISMA guidelines. Results Data concerning the efficacy of self-expanding stents in the treatment of leaks/fistulas after bariatric surgery were extracted from 40 studies (493 patients). The overall proportion of successful leak/fistula closure was 92% (95% CI, 90-95%). The overall proportion of stent migration was 23% (95% CI, 19-28%). Seventeen papers (98 patients) reported the use of clipping: the over-the-scope clips (OTSC) system was used in 85 patients with a successful closure rate of 67.1% and a few complications (migration, stenosis, tear). The successful fistula/leak closure using other than OTSC types was achieved in 69.2% of patients. In 10 case series (63 patients), fibrin glue alone was used with a 92.8-100% success rate of fistula closure that usually required repeated sessions at scheduled intervals. The complications of fibrin glue applications were reported in only one study and included pain and fever in 12.5% of patients. Conclusions Endoscopic techniques are effective for management of post-bariatric leaks and fistulas in properly selected patients.

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Endoscopic Treatment of Complications After Bariatric Surgery

Silva

Amorim²,

Campos³

et al. 2021

Obesity, Bariatric and Metabolic Surgery

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Endoscopic management of a gastric leak after laparoscopic sleeve gastrectomy using the over-the-scope-clip (Ovesco®) system

Cited by 7 publications

References 17 publications

Staple line leak with peritonitis after laparoscopic sleeve gastrectomy - a solution in one to six steps.

Staple line leak with peritonitis after laparoscopic sleeve gastrectomy - a solution in one to six steps.

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

Endoscopic Treatment of Complications After Bariatric Surgery

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