Laparoscopic Roux-En-Y Fistulo-Jejunostomy, a Preferred Technique after Failure of Endoscopic and Radiologic Management of Fistula Post Sleeve Gastrectomy

Amor, Imed Ben; Debs, Tarek; Dalmonte, Giorgio; Kassir, Radwan; Baqué, Patrick; Petrucciani, Niccolò; Gugenheim, Jean

doi:10.1007/s11695-018-03644-z

Cited by 5 publications

(8 citation statements)

References 6 publications

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“…Surgical management also has a role as a step up, escalation therapy, when more conservative treatments fail 199,216. In hemodynamically stable patients a trial of nonsurgical interventions should be attempted for at least 3 months before considering surgery 47,68,188,195,217,218.…”

Section: Surgical Managementmentioning

confidence: 99%

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A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks

Gjeorgjievski¹,

Imam

Cappell

et al. 2020

Journal of Clinical Gastroenterology

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Background: Bariatric surgery leaks result in significant morbidity and mortality. Experts report variable therapeutic approaches, without uniform guidelines or consensus.Objective: To review the pathogenesis, risk factors, prevention, and treatment of gastric sleeve leaks, with a focus on endoscopic approaches. In addition, the efficacy and success rates of different treatment modalities are assessed.Design: A comprehensive review was conducted using a thorough literature search of 5 online electronic databases (PubMed, PubMed Central, Cochrane, EMBASE, and Web of Science) from the time of their inception through March 2020. Studies evaluating gastric sleeve leaks were included. MeSH terms related to "endoscopic," "leak," "sleeve," "gastrectomy," "anastomotic," and "bariatric" were applied to a highly sensitive search strategy. The main outcomes were epidemiology, pathophysiology, diagnosis, treatment, and outcomes.Results: Literature search yielded 2418 studies of which 438 were incorporated into the review. Shock and peritonitis necessitate early surgical intervention for leaks. Endoscopic therapies in acute and early leaks involve modalities with a focus on one of: (i) defect closure, (ii) wall diversion, or (iii) wall exclusion. Surgical revision is required if endoscopic therapies fail to control leaks after 6 months. Chronic leaks require one or more endoscopic, radiologic, or surgical approaches for fluid collection drainage to facilitate adequate healing. Success rates depend on provider and center expertise. Conclusion:Endoscopic management of leaks post sleeve gastrectomy is a minimally invasive and effective alternative to surgery. Their effect may vary based on clinical presentation, timing or leak morphology, and should be tailored to the appropriate endoscopic modality of treatment.

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Section: Surgical Managementmentioning

confidence: 99%

“…Presence of intra-abdominal collections determines the need for drainage 216. Undrained collections should be drained externally (percutaneously) by surgical or radiologic approach, or internally by endoscopic approach 47,192,205,234–236.…”

Section: Endoscopic Managementmentioning

confidence: 99%

A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks

Gjeorgjievski¹,

Imam

Cappell

et al. 2020

Journal of Clinical Gastroenterology

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“…Given that the high-pressure milieu within the gastric sleeve is a major factor for the development and recalcitrance of staple line leak [ 8 ], different treatment strategies such as performing a fistula-jejunostomy [ 33 ], a salvage total gastrectomy with oesophago-jejunostomy, and placing an endoscopic internal drainage (EID) help to overcome the high-pressure system with beneficial effects on the course of SLL. However, surgery might be challenging and is associated with several complications when performed in an infected field.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Negative Pressure Therapy (ENPT) Is Superior to Stent Therapy for Staple Line Leak After Sleeve Gastrectomy: a Single-Center Cohort Study

et al. 2021

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Purpose Staple line leak (SLL) is a serious complication after sleeve gastrectomy (SG). Common endoscopic treatment options include self-expandable metallic stent (SEMS), endoscopic internal drainage (EID), and endoscopic closure. The endoscopic negative pressure therapy (ENPT) is a promising treatment option combining temporary sealing of the defect with drainage of the inflammatory bed. In this study, we compare the outcome of ENPT and SEMS for the treatment of SLL following SG. Materials and Methods A retrospective cohort of 27 patients (21 females) treated at a single center for SLL after SG was included. ENPT was primary therapy for 14 patients and compared with 13 patients treated primarily using SEMS. Results ENPT was associated with a significant reduction of hospital stay (19 ± 15.1 vs. 56.69 ± 47.21 days, p = 0.027), reduced duration of endoscopic treatment (9.8 ± 8.6 vs. 44.92 ± 60.98 days, p = 0.009), and shorter transabdominal drain dwell time (15 (5–96) vs. 45 (12–162) days, p = 0.014) when compared to SEMS. Whereas endoscopic management was successful in 12/14 (85.7%) of patients from the ENPT group, SEMS was successful in only 5/13 (38.5%) of patients (p = 0.015). Furthermore, ENPT was associated with a significant reduction of endoscopic adverse events compared with SEMS (14.3% vs. 76.92% p = 0.001). Conclusion Compared with SEMS, ENPT is effective and safe in treating SLL after SG providing higher success rates, shorter treatment duration, and lower adverse events rates.

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“…132 Among the three revisions, RYGB has the highest reoccurrence rate of leak, 130 and patients who underwent gastrectomy have a relatively high risk of complications related to esophagojejunal anastomosis, nutritional deficiencies, and anemia. 133 LRYEJ seems more safe and effective but with higher complications. 134 LRYEJ is a well-characterized approach that anastomoses a fistula site to a small bowel loop.…”

Section: Revisional Surgeries For Gastric Leakmentioning

confidence: 93%

“…In China, 84.8% of surgeons consider Roux-en-Y bypass as a salvage procedure, 142 whereas some researchers regard LRYEJ as a suitable technique after the failure of the endoscopic management of post-sleeve gastrectomy fistula. 133,134,143 The determination of surgical methods depends mainly on patient disposition.…”

Section: Revisional Surgeries For Gastric Leakmentioning

confidence: 99%

Revisional Surgeries of Laparoscopic Sleeve Gastrectomy

Li¹,

Jiao²,

Zhang³

et al. 2021

DMSO

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Bariatric surgery has become increasingly common due to the worldwide obesity epidemic. A shift from open to laparoscopic surgery, specifically, laparoscopic sleeve gastrectomy (LSG), has occurred in the last two decades because of the low morbidity and mortality rates of LSG. Although LSG is a promising treatment option for patients with morbid obesity due to restrictive and endocrine mechanisms, it requires modifications for a subset of patients because of weight regain and tough complications, such as gastroesophageal reflux, strictures, gastric leak, and persistent metabolic syndrome., Revision surgeries have become more and more indispensable in bariatric surgery, accounting for 7.4% in 2016. Mainstream revisional bariatric surgeries after LSG include Roux-en-Y gastric bypass, repeated sleeve gastrectomy, biliopancreatic diversion, duodenal switch, duodenal-jejunal bypass, one-anastomosis gastric bypass, single anastomosis duodeno-ileal bypass (SAID) and transit bipartition. This review mainly describes the revisional surgeries of LSG, including the indication, choice of surgical method, and subsequent effect.

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Laparoscopic Roux-En-Y Fistulo-Jejunostomy, a Preferred Technique after Failure of Endoscopic and Radiologic Management of Fistula Post Sleeve Gastrectomy

Cited by 5 publications

References 6 publications

A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks

A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks

Endoscopic Negative Pressure Therapy (ENPT) Is Superior to Stent Therapy for Staple Line Leak After Sleeve Gastrectomy: a Single-Center Cohort Study

Revisional Surgeries of Laparoscopic Sleeve Gastrectomy

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