Therapy of Stenosis after Sleeve Gastrectomy: Stent and Surgery as Alternatives – Case Reports

Abstract

Aim: The growing enthusiasm to perform laparoscopic sleeve gastrectomy (LSG) in morbidly obese patients exposes also the complications associated with this type of surgery. LSG is not only performed in super-super-obese patients, but in addition has also its standing as a procedure in patients with multiple intraabdominal adhesions based on prior surgeries or after failed gastric banding. However, over the years there are characteristic complications as demonstrated by the increasing number of surgical interventions. Beside the risk of an insufficiency at the staple line, there is just as well the risk of a stenosis. Case Reports: The case reports will present several ways of the treatment that can be regarded as alternative approaches. Conclusion: The final decision to perform a surgery or to implant a stent needs to be calculated from case to case. This demonstrates the importance of an experienced team of surgeons and endoscopists.

Endoscopic vacuum therapy in salvage and standalone treatment of gastric leaks after bariatric surgery

“…However, there is no cost advantage for stent therapy once a second stent is required, such as in cases of stent migration or inadequate leak sealing. Those cases are reported to occur in 30-50% of all stent therapy cases [1,[6][7][8][9][10]13].…”

“…In the current literature, endoscopic stent implantation is increasingly used for GL treatment, with a treatment duration between 21 and 240 days [1,[6][7][8][9][10]. The rate of full recovery was reported to be 75-100%.…”

“…Two to three endoscopies are regularly needed for stent therapy. The most common disadvantages are stent migration (30-50%) and the necessity of external drainage of the wound cavity which is often challenging in obesity patients [1,[6][7][8][9][10]13]. Kanters et al [14] reported in an MBSAQIP database analysis of 275 stent therapy in GL after bariatric surgery that 50% patients with GL need more than one stent and a higher likelihood of readmission.…”

“…Studies on employing endoscopic stenting for GL treatment in bariatric surgery report healing rates of 80-100%. However, such approaches come with risk of stent migration, insufficient leak sealing, persistent peritonitis, and dysphagia [6][7][8][9][10][11][12][13][14].…”