Management of gastric leaks after sleeve gastrectomy with endoluminal vacuum (E-Vac) therapy

Leeds, Steven G.; Burdick, J. Steven

doi:10.1016/j.soard.2016.01.017

Cited by 107 publications

(68 citation statements)

References 25 publications

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“…Alternative endoscopic treatment options for staple line leakage include over-the-scope clipping, overstitching of the leak in case of small leaks, endoluminal vacuum therapy, or drainage with a pigtail [25–28]. However, due to the small number of patients in these studies and the lack of prospective studies and studies comparing different treatment options, it is yet unclear which treatment option has the highest chance of success.…”

Section: Discussionmentioning

confidence: 99%

A novel fully covered double-bump stent for staple line leaks after bariatric surgery: a retrospective analysis

et al. 2018

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BackgroundStaple line leakage after bariatric surgery can be treated by endoscopic placement of a self-expandable stent. The success rate of stent placement is generally high, but migration is a frequent adverse event that hampers successful treatment. The Niti-S Beta stent is a fully covered double-bump stent that was specifically designed to prevent migration. This study aimed to evaluate the effectiveness and adverse event rate of the Niti-S Beta stent.MethodsA retrospective study was performed in three high-volume bariatric centers. All consecutive patients between 2009 and 2016 who underwent placement of a Beta stent for staple line leakage were included. Primary outcome was resolution of the leakage; secondary outcome was the adverse event rate including migration.ResultsThirty-eight patients were included. Twenty-five (66%) had resolution of the leakage. Success rate was higher in patients who were treated with implantation of a Beta stent as initial treatment (100%) than in patients who were treated with a stent after revisional surgery had failed (55%, p = 0.013). Migration occurred in 12 patients (32%). There were two severe adverse events requiring surgical intervention, including a bleeding from an aorto-esophageal fistula.ConclusionsThe success rate and the migration rate of the Beta stent seem comparable to other stents in this retrospective study. Despite the novel double-bump structure of the stent, the migration rate does not seem to be decreased.

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Section: Discussionmentioning

confidence: 99%

A novel fully covered double-bump stent for staple line leaks after bariatric surgery: a retrospective analysis

et al. 2018

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“…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]. The e-VAC system with gastroscopy offers another, rather rare, solution [15]. …”

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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“…This procedure allows decreasing intragastric pressure, rerouting the gastric content and the internal drainage of the cavity by cutting the staple-line interposed between the cavity and the gastric lumen[92,93]. Anecdotal experience with internal drainage using a vacuum-assisted closure system is now available[94,95]. This device consists of a sponge endoscopically placed inside the cavity and connected by a transnasal tube to external continuous vacuum suction[96].…”

Section: Anastomotic Leaks and Fistulasmentioning

confidence: 99%

“…The rescue rate was 89% after an average of 50 d and 10.3 procedures per patient. One patient required surgery and in two others, a complementary over-the-scope clip was placed[95]. …”

Section: Anastomotic Leaks and Fistulasmentioning

confidence: 99%

Endoluminal solutions to bariatric surgery complications: A review with a focus on technical aspects and results

Souto-Rodríguez¹,

Alvarez-Sánchez²

2017

WJGE

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Obesity is a growing problem in developed countries, and surgery is the most effective treatment in terms of weight loss and improving medical comorbidity in a high proportion of obese patients. Despite the advances in surgical techniques, some patients still develop acute and late postoperative complications, and an endoscopic evaluation is often required for diagnosis. Moreover, the high morbidity related to surgical reintervention, the important enhancement of endoscopic procedures and technological innovations introduced in endoscopic equipment have made the endoscopic approach a minimally-invasive alternative to surgery, and, in many cases, a suitable first-line treatment of bariatric surgery complications. There is now evidence in the literature supporting endoscopic management for some of these complications, such as gastrointestinal bleeding, stomal and marginal ulcers, stomal stenosis, leaks and fistulas or pancreatobiliary disorders. However, endoscopic treatment in this setting is not standardized, and there is no consensus on its optimal timing. In this article, we aim to analyze the secondary complications of the most expanded techniques of bariatric surgery with special emphasis on those where more solid evidence exists in favor of the endoscopic treatment. Based on a thorough review of the literature, we evaluated the performance and safety of different endoscopic options for every type of complication, highlighting the most recent innovations and including comparative data with surgical alternatives whenever feasible.

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Management of gastric leaks after sleeve gastrectomy with endoluminal vacuum (E-Vac) therapy

Cited by 107 publications

References 25 publications

A novel fully covered double-bump stent for staple line leaks after bariatric surgery: a retrospective analysis

A novel fully covered double-bump stent for staple line leaks after bariatric surgery: a retrospective analysis

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

Endoluminal solutions to bariatric surgery complications: A review with a focus on technical aspects and results

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