Login Register Cart 0
Generic placeholder image

Reviews on Recent Clinical Trials

Editor-in-Chief

ISSN (Print): 1574-8871
ISSN (Online): 1876-1038

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Management of Leaks Following Laparoscopic Sleeve Gastrectomy Using Specifically Designed Large Covered Metal Stents

Author(s): Carmelo Luigiano*, Milena Di Leo, Leonardo Henry Eusebi, Matteo Barabino, Enrico De Nicola, Marco Giovenzana, Enrico Opocher, Giuseppe Iabichino, Maria Angela Palamara, Giuseppa Giacobbe, Andrea Tortora, Clara Virgilio, Ludovico Abenavoli, Socrate Pallio and Pierluigi Consolo

Volume 16, Issue 3, 2021

Published on: 04 February, 2021

Page: [303 - 308] Pages: 6

DOI: 10.2174/1574887116666210204142417

Price: $65

Abstract

Background: Leaks are the major complication associated with laparoscopic sleeve gastrectomy.

Objective: The study aimed to assess the efficacy and safety of specifically designed large covered metal stents for the management of post-laparoscopic sleeve gastrectomy leaks.

Methods: Prospectively collected databases from three Italian Endoscopy Units were reviewed. The primary outcome of the study was to evaluate the clinical success of stents placement, defined as complete resolution of clinical and laboratory signs of sepsis with radiological evidence of leak closure. Secondary outcomes were stent-related adverse events and mortality.

Results: Twenty-one patients (67% females, mean age 45 years) were included in the study and a total of 26 stents were placed. Technical success of stent placement was achieved in all cases (100%). Clinical success was observed in 85.5% of patients. Stent-related adverse events occurred in 9 patients (43%), with stent migration as the most frequent complication (33%). Adverse events were more frequently observed in patients who had undergone bariatric surgery prior to laparoscopic sleeve gastrectomy compared to patients without previous surgery (83% et al. 27%, p=0.018).

Conclusion: The placement of specifically designed covered metal stents appears to be an effective and safe therapeutic approach for post-laparoscopic sleeve gastrectomy leaks. Stent migration can be a frequent complication.

Keywords: Upper endoscopy, fistula, sleeve gastrectomy, covered metal stents, leaks, bariatric surgery.

« Previous Next »
Graphical Abstract

[1]
Iossa A, Abdelgawad M, Watkins BM, Silecchia G. Leaks after laparoscopic sleeve gastrectomy: Overview of pathogenesis and risk factors. Langenbecks Arch Surg 2016; 401(6): 757-66.
[http://dx.doi.org/10.1007/s00423-016-1464-6] [PMID: 27301373]
[2]
Shehab H. Enteral stents in the management of post-bariatric surgery leaks. Surg Obes Relat Dis 2018; 14(3): 393-403.
[http://dx.doi.org/10.1016/j.soard.2017.12.014] [PMID: 29428690]
[3]
Eisendrath P, Deviere J. Major complications of bariatric surgery: Endoscopy as first-line treatment. Nat Rev Gastroenterol Hepatol 2015; 12(12): 701-10.
[http://dx.doi.org/10.1038/nrgastro.2015.151] [PMID: 26347162]
[4]
Spaander MC, Baron TH, Siersema PD, et al. Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016; 48(10): 939-48.
[http://dx.doi.org/10.1055/s-0042-114210] [PMID: 27626318]
[5]
Kim J, Azagury D, Eisenberg D, DeMaria E, Campos GM. ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management. Surg Obes Relat Dis 2015; 11(4): 739-48.
[http://dx.doi.org/10.1016/j.soard.2015.05.001] [PMID: 26071849]
[6]
Okazaki O, Bernardo WM, Brunaldi VO, et al. Efficacy and safety of stents in the treatment of fistula after bariatric Surgery: a systematic review and meta-analysis. Obes Surg 2018; 28(6): 1788-96.
[http://dx.doi.org/10.1007/s11695-018-3236-6] [PMID: 29654447]
[7]
Galloro G, Magno L, Musella M, Manta R, Zullo A, Forestieri P. A novel dedicated endoscopic stent for staple-line leaks after laparoscopic sleeve gastrectomy: A case series. Surg Obes Relat Dis 2014; 10(4): 607-11.
[http://dx.doi.org/10.1016/j.soard.2014.02.027] [PMID: 24935179]
[8]
Fishman S, Shnell M, Gluck N, Meirsdorf S, Abu-Abeid S, Santo E. Use of sleeve-customized self-expandable metal stents for the treatment of staple-line leakage after laparoscopic sleeve gastrectomy. Gastrointest Endosc 2015; 81(5): 1291-4.
[http://dx.doi.org/10.1016/j.gie.2014.11.012] [PMID: 25733128]
[9]
Liu SY, Wong SK, Ng EK. Novel oesophago-gastro-duodenal stenting for gastric leaks after laparoscopic sleeve gastrectomy. Obes Res Clin Pract 2015; 9(3): 214-9.
[http://dx.doi.org/10.1016/j.orcp.2014.11.007] [PMID: 25534492]
[10]
van Wezenbeek MR, de Milliano MM, Nienhuijs SW, Friederich P, Gilissen LP. A specifically designed stent for anastomotic leaks after bariatric surgery: Experiences in a tertiary referral hospital. Obes Surg 2016; 26(8): 1875-80.
[http://dx.doi.org/10.1007/s11695-015-2027-6] [PMID: 26699374]
[11]
Tringali A, Bove V, Perri V, et al. Endoscopic treatment of post-laparoscopic sleeve gastrectomy leaks using a specifically designed metal stent. Endoscopy 2017; 49(1): 64-8.
[PMID: 27706525]
[12]
Klimczak T, Klimczak J, Szewczyk T, Janczak P, Jurałowicz P. Endoscopic treatment of leaks after laparoscopic sleeve gastrectomy using MEGA esophageal covered stents. Surg Endosc 2018; 32(4): 2038-45.
[http://dx.doi.org/10.1007/s00464-017-5900-7] [PMID: 29052063]
[13]
Boerlage TCC, Houben GPM, Groenen MJM, et al. A novel fully covered double-bump stent for staple line leaks after bariatric surgery: A retrospective analysis. Surg Endosc 2018; 32(7): 3174-80.
[http://dx.doi.org/10.1007/s00464-018-6034-2] [PMID: 29344787]
[14]
Shehab H, Abdallah E, Gawdat K, Elattar I. Large bariatric-specific stents and over-the-scope clips in the management of post-bariatric surgery leaks. Obes Surg 2018; 28(1): 15-24.
[http://dx.doi.org/10.1007/s11695-017-2808-1] [PMID: 28702740]
[15]
de Moura DTH, de Moura EGH, Neto MG, et al. Outcomes of a novel bariatric stent in the management of sleeve gastrectomy leaks: a multicenter study. Surg Obes Relat Dis 2019; 15(8): 1241-51.
[http://dx.doi.org/10.1016/j.soard.2019.05.022] [PMID: 31262650]
[16]
Hamed H, Said M, Elghadban H, Elgeidie A. Outcome and adverse events of endoscopic bariatric stents for management of leakage after bariatric surgery. Obes Surg 2020; 30(3): 982-91.
[http://dx.doi.org/10.1007/s11695-019-04373-7] [PMID: 31902044]
[17]
Bruce J, Krukowski ZH, Al-Khairy G, Russell EM, Park KG. Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg 2001; 88(9): 1157-68.
[http://dx.doi.org/10.1046/j.0007-1323.2001.01829.x] [PMID: 11531861]
[18]
Rosenthal RJ, Diaz AA, Arvidsson D, et al. International sleeve gastrectomy expert panel consensus statement: Best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis 2012; 8(1): 8-19.
[http://dx.doi.org/10.1016/j.soard.2011.10.019] [PMID: 22248433]
[19]
Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71(3): 446-54.
[http://dx.doi.org/10.1016/j.gie.2009.10.027] [PMID: 20189503]

Rights & Permissions Print Cite
Article Metrics
11
© 2024 Bentham Science Publishers | Privacy Policy