Management of Staple Line Leaks Following Sleeve Gastrectomy—a Systematic Review

Hughes, David; Hughes, Ioan; Khanna, Arun

doi:10.1007/s11695-019-03896-3

Cited by 29 publications

(29 citation statements)

References 54 publications

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“…Endoscopic stent implantation successfully treated GL in 69.6% of our patients. This result is consistent with published studies (success ranging from 65 to 100%) [ 9 – 22 , 32 ] and with systematic reviews (up to 87.8%) [ 33 ]. However, in cases where stent therapy was performed with a MS, the success rate was significantly higher (90.9 vs. 50.0% respectively, p = 0.006), which is also in line with the available literature [ 10 – 13 , 15 – 20 , 34 – 40 ].…”

Section: Discussionsupporting

confidence: 93%

“…In combination with the sealing effect of the stent, this may also reflect successful dilatation of a possible (relative) stenosis distal to the fistula (GL is frequently the consequence of such a stenosis) (i.e. stent may restore the balance of pressure between the proximal and distal parts of the stomach) afforded by the stent [ 25 , 33 , 41 ]. In turn, this may facilitate healing in a more uniform manner due to equilibration of intraluminal pressure and also underpin the benefits of MS over SS, given that the latter only affords partial coverage of the gastric sleeve.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic Stent Placement Can Successfully Treat Gastric Leak Following Laparoscopic Sleeve Gastrectomy If and Only If an Esophagoduodenal Megastent Is Used

et al. 2021

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Purpose Gastric staple line leakage (GL) is a serious complication of laparoscopic sleeve gastrectomy (LSG), with a specific mortality ranging from 0.2 to 3.7%. The current treatment of choice is stent insertion. However, it is unclear whether the type of stent which is inserted affects treatment outcome. Therefore, we aimed not only to determine the effectiveness of stent treatment for GL but also to specifically clarify whether treatment outcome was dependent on the type of stent (small- (SS) or megastent (MS)) which was used. Patients and Methods A single-centre retrospective study of 23 consecutive patients was conducted to compare the outcomes of SS (n = 12) and MS (n = 11) for the treatment of GL following LSG. The primary outcome measure was the success rate of stenting, defined as complete healing of the GL without changing the treatment strategy. Treatment change or death were both coded as failure. Results The success rate of MS was 91% (10/11) compared to only 50% (6/12) for SS (p = 0.006). An average of 2.3 ± 0.5 and 6.8 ± 3.7 endoscopies were required to achieve healing in the MS and SS groups respectively (p < 0.001). The average time to resumption of oral nutrition was shorter in the MS group (1.4 ± 1.1 days vs. 23.1 ± 33.1 days, p = 0.003). Conclusions Stent therapy is only effective and safe for the treatment of GL after LSG if a MS is used. Treatment with a MS may not only increase treatment success rates but may also facilitate earlier resumption of oral nutrition and shorten the duration of hospitalization. Graphical Abstract

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Endoscopic Stent Placement Can Successfully Treat Gastric Leak Following Laparoscopic Sleeve Gastrectomy If and Only If an Esophagoduodenal Megastent Is Used

et al. 2021

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“…Similarly, the pooled prevalence of overall complications was 7.6% (95%CI 5 3.1%-13.4%) with a moderate related heterogeneity (I 2 5 52.9%, P 5 .024). It is interesting to observe that the estimated pooled prevalence of postoperative leak and overall complications web 4C=FPO seem equivalent to other studies reporting leak and overall complications rate after primary LSG [1,3,36,37]. However, caution is mandatory while interpreting these results because the moderate heterogeneity potentially influenced by diverse surgical technique, surgeons' experience, preoperative gastric volumetry, outcomes reporting, definition of postoperative complications, preoperative co-morbidities, and patients' selection bias.…”

Section: Discussionmentioning

confidence: 75%

Resleeve for failed laparoscopic sleeve gastrectomy: systematic review and meta-analysis

Aiolfi

Micheletto

Marin

et al. 2020

Surgery for Obesity and Related Diseases

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Despite excellent long-term results, insufficient weight loss, weight regain, and pathologic gastroesophageal reflux disease may require revisional procedures after laparoscopic sleeve gastrectomy (LSG). Resleeve gastrectomy (ReSG) for failed LSG, has been proposed as an alternative to more complex malabsorptive procedures. The aim of this systematic review and meta-analysis was to examine the current evidence on the therapeutic role and outcomes of ReSG for failed LSG. PubMed, EMBASE, and Web of Science data sets were consulted. A systematic review and Frequentist metaanalysis were performed. Ten studies published between 2010 and 2019 met the inclusion criteria for a total of 300 patients. The age of the patient population ranged from 20 to 66 years old and 80.5% were females. The elapsed time between the LSG and ReSG ranged from 9 to 132 months. The estimated pooled prevalence of postoperative leak and overall complications were 2.0% (95% confidence interval [CI] 5 .5%-4.7%) and 7.6% (95%CI 5 3.1%-13.4%). The estimated pooled mean operative time and hospital length of stay were 51 minutes (95%CI 5 49.4-52.6) and 3.3 days (95%CI 5 3.13-3.51). The postoperative follow-up ranged from 12 to 36 months and the estimated pooled mean percentage excess weight loss was 61.46% (95%CI 5 55.9-66.9). The overall mortality ranged from 0% to 2.2%. ReSG after failed LSG seems feasible and safe with acceptable postoperative leak rate, overall complications, and mortality. The effectiveness of ReSG in term of weight loss seems promising in the short-term but further studies are warranted to explore its effect on patients' quality of life, postoperative gastroesophageal reflux disease, and long-term weight loss. (Surg Obes Relat Dis 2020;-:1-9.

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“…Similarly, in Murino et al's study, 14% of the patients had stricture as a complication, 5% had hemorrhage, and 2% had perforation. 16 A systematic review by Hughes et al 17 included 26 articles on different treatment methods of post sleeve gastrectomy leakage, and it showed 62% success rate in patients who initially treated endoscopically, 76% in patient who were managed surgically, and 82% in patients managed conservatively.…”

Section: Discussionmentioning

confidence: 99%

Gastroesophageal Stents for the Management of Post Sleeve Gastrectomy Leakage: Interventional Radiology Experience

Dahmash

Arabi

Alfutais

et al. 2021

The Arab Journal of Interventional Radiology

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Objective The aim of this study was to assess the efficacy and safety of retrievable, self-expandable gastroesophageal stents to manage gastric leaks post sleeve gastrectomy by interventional radiology (IR). Methods This is a retrospective study of patients with gastric leaks post sleeve gastrectomy who were managed with gastroesophageal stent placement. The diameters of the stents ranged from 23 to 30 mm and the lengths 12.5 to 24 cm. Results Thirty-one patients (mean age, 32.4 ± 7.97 years) were included in the study, and 46 stents were placed. The total average stenting time was 59.1 ± 35.5 days. Leakage resolved in 93.5% of the patients. Thirty-eight (82.6%) of the stents were retrieved by IR, and the remaining stents were retrieved under endoscopic visualization. Stricture occurred as a complication in four patients: three of which were treated with stenting (one by IR and two by endoscopy) and one required esophagoplasty. Six patients experienced stent migration, three of which underwent stent adjustment, while the remaining three underwent stent reinsertion Conclusion Gastroesophageal stent placement by IR for gastric leaks post sleeve gastrectomy is safe and effective in our study.

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Management of Staple Line Leaks Following Sleeve Gastrectomy—a Systematic Review

Cited by 29 publications

References 54 publications

Endoscopic Stent Placement Can Successfully Treat Gastric Leak Following Laparoscopic Sleeve Gastrectomy If and Only If an Esophagoduodenal Megastent Is Used

Endoscopic Stent Placement Can Successfully Treat Gastric Leak Following Laparoscopic Sleeve Gastrectomy If and Only If an Esophagoduodenal Megastent Is Used

Resleeve for failed laparoscopic sleeve gastrectomy: systematic review and meta-analysis

Gastroesophageal Stents for the Management of Post Sleeve Gastrectomy Leakage: Interventional Radiology Experience

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