Leaks in fixed-ring banded sleeve gastrectomies: a management approach

Foo, Jonathan; Balshaw, James; Tan, Michael H.L.; Tan, Jeremy

doi:10.1016/j.soard.2017.03.031

Cited by 5 publications

(4 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Managing leaks has varied amongst experts and is based on personal experience. Therefore, at present there is a lack of consensus in approaching and treating leaks 35,41,55,56,94,102,125,181,185,189–201. Lack of prospective, randomized controlled trials renders guidelines more difficult, and most data come from retrospective studies, reviews, and expert opinions 125,137,187,191…”

Section: Overview Of Managementmentioning

confidence: 99%

“…Therefore, at present there is a lack of consensus in approaching and treating leaks. 35,41,55,56,94,102,125,181,185,[189][190][191][192][193][194][195][196][197][198][199][200][201] Lack of prospective, randomized controlled trials renders guidelines more difficult, and most data come from retrospective studies, reviews, and expert opinions. 125,137,187,191 A multidisciplinary approach including surgery, gastroenterology, and interventional radiology is essential to manage these complex patients.…”

Section: Overview Of Managementmentioning

confidence: 99%

“…FIGURE 5. Algorithm in endoscopic management of sleeve gastrectomy leaks: a combined algorithm created on the available data and similar algorithms 35,41,55,94,102,125,181,185,[192][193][194][195][196][197][198][199][200][201]. TTS indicates through the scope clips.…”

mentioning

confidence: 99%

See 2 more Smart Citations

A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks

Gjeorgjievski¹,

Imam

Cappell

et al. 2020

Journal of Clinical Gastroenterology

View full text Add to dashboard Cite

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.

show abstract

Section: Overview Of Managementmentioning

confidence: 99%

Section: Overview Of Managementmentioning

confidence: 99%

See 1 more Smart Citation

A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks

Gjeorgjievski¹,

Imam

Cappell

et al. 2020

Journal of Clinical Gastroenterology

View full text Add to dashboard Cite

show abstract

“…The use of EID with DPTs for laparoscopic sleeve gastrectomy leaks is now well established in the literature. [17][18][19][20] Surgeons and endoscopists have been quick to extrapolate this usage to the management of all UGI leaks, including UGI anastomotic leaks. This has been employed in a few centers with encouraging results.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic internal drainage with double pigtail stents for upper gastrointestinal anastomotic leaks: suitable for all cases?

et al. 2022

View full text Add to dashboard Cite

Background/Aims: Surgeons and endoscopists have started to use endoscopically inserted double pigtail stents (DPTs) in the management of upper gastrointestinal (UGI) leaks, including UGI anastomotic leaks. We investigated our own experiences in this patient population. Methods: From March 2017 to June 2020, 12 patients had endoscopic internal drainage of a radiologically proven anastomotic leak after UGI surgery in two tertiary UGI centers. The primary outcome measure was the time to removal of the DPTs after anastomotic healing. The secondary outcome measure was early oral feeding after DPT insertion. Results: Eight of the 12 patients (67%) required only one DPT, whereas four (33%) required two DPTs. The median duration of drainage was 42 days. Two patients required surgery due to inadequate control of sepsis. Of the remaining ten patients, nine (90%) did not require a change in DPT before anastomotic healing. Nine patients were allowed oral fluids within the first week and a soft diet in the second week. One patient was allowed clear oral feeds on the 8th day after DPT insertion. Conclusions: Endoscopic internal drainage is becoming an established minimally invasive technique for controlling anastomotic leak after UGI surgery. It allows for early oral nutritional feeding and minimizes discomfort from conventional external drainage.

show abstract