Endoscopic stenting for laparoscopic sleeve gastrectomy leaks

Abstract

Objective: Laparoscopic sleeve gastrectomy is a widely accepted and effective bariatric surgery method. The rate of leakage at the staple-line has been reported to be between 1.5 and 5%. Aside from the use of percutaneous drainage, re-laparoscopy, or abdominal sepsis control by laparotomy, endoscopic esophagogastric stent placement is increasingly preferred as a treatment method. Because laparoscopic sleeve gastrectomy is a widely used modality in our hospital, we aimed to evaluate the rate of leaks and the results of stent placements in our patients.
Material and Methods: Between January 1st 2010 and August 31st 2014, laparoscopic sleeve gastrectomy was performed on 236 patients by three surgeons. The demographic information and postoperative discharge summaries were collected and analyzed with the permission of the hospital ethics committee. Information about leak treatment management was also collected.
Results: Leaks after laparoscopic sleeve gastrectomy in four patients were stented in the first postoperative month. Short (12 cm) Hanora® (M.I.Tech, Gyeonggi-do, Korea) self-expandable coated stents were placed in two patients, and long (24 cm) Hanora® self-expandable coated stents were placed in the other two. The stents were removed after one month in two patients, two and a half months later in one, and five months later in another patient. The leaks were demonstrated to be healed in all patients after stent removal. Endoscopic stent revision was performed in one patient due to migration of the stent and in another for stent breakage.
Conclusion: The success rate of treatment of leaks after laparoscopic sleeve gastrectomy by stent placement has been variable in the literature. The success in early stent placement has been shown to be related to physician expertise. According to the results of our patients, we suggest that endoscopic stent placement in the early stage after controlling sepsis is an effective method in the management of leaks.

Ethics committee approval was received for this study from the ethics committee of Fatih Sultan Mehmet Training and Research Hospital.

Written informed consent was obtained from patients who participated in this study.

Externally peer-reviewed.

Concept - M.T.A., Y.Ö.A., O.A.; Design - M.T.A., Y.Ö.A.; Supervision - M.T.A., Y.Ö.A.; Resources - O.A., B.K., Y.İ; Data Collection and/or Processing - M.T.A., O.A.; Analysis and/or Interpretation - M.T.A., Y.Ö.A., O.A.; Literature Search - M.T.A., O.A.; Writing Manuscript - M.T.A.; Critical Review - Y.Ö.A., K.M., E.O.

No conflict of interest was declared by the authors.

The authors declared that this study has received no financial support.