Successful Management of Refractory Staple Line Leakage at the Esophagogastric Junction After a Sleeve Gastrectomy Using the HANAROSTENT

Abstract

The esophagogastric junction (EGJ) is a potential site of leakage after a sleeve gastrectomy which is usually difficult to treat conservatively. Two patients underwent a laparoscopic sleeve gastrectomy. A subphrenic abscess due to a staple line leakage was detected by CT at 3 weeks and 10 days after the operation, respectively. The abscess was drained laparoscopically. Intractable leakage required several endoscopic treatments, including clipping and sealing. However, a persisting fistula was found on radiographic studies. A covered self-expandable and retrievable stent (HANAROSTENT) was finally placed over the leakage site at 15 and 6 weeks after the reoperation, respectively. Oral intake was achieved from poststent day 1, and they were discharged 2 weeks after stenting. Three months later, the stent was endoscopically removed and the leakage was successfully sealed. The HANAROSTENT is therefore considered to be a safe and effective therapeutic option for the management of staple line leakage at the EGJ.

Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients

“…This suggests that approximately 79% of leaks will occur as a late event, and the majority will be managed by minimally invasive means, including endoscopic stenting. Oshiro et al published that operative management often fails to resolve the leak due to poor tissues and inflammation [15]. Operative management is useful for debridement and drainage, but closure of the defect usually fails due to the poor tissues.…”

Complications associated with laparoscopic sleeve gastrectomy for morbid obesity: a surgeon’s guide

“…Other investigators have also used intraluminal stents for the management of gastric leaks. 20,21 Himpens and colleagues 20 reported their experience in the management of 29 patients with gastric leak after sleeve gastrectomy with stenting. These investigators left the stents in situ on average for 7 weeks.…”

Splenic abscess secondary to sleeve gastrectomy leak

“…Operative management may be useful for debridement and drainage; however, primary closure is usually heralded by poor tissues and inflammation. [6] Endoscopic stents have emerged for the management of gastric leaks but are only amenable for leaks at the proximal and mid-aspects of the sleeve. In addition, adequate drainage of any abdominal collection is of utmost importance.…”