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Treatment of Leaks Following Sleeve Gastrectomy by Endoscopic Internal Drainage (EID)

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Abstract

Background

Leaks are considered one of the major complications of laparoscopic sleeve gastrectomy (LSG) with a reported rate up to 7 %. Drainage of the collection coupled with SEMS deployment is the most frequent treatment. Its success is variable and burdened by high morbidity and not irrelevant mortality. The aim of this paper is to suggest and establish a new approach by endoscopic internal drainage (EID) for the management of leaks.

Methods

Since March 2013, 67 patients presenting leak following LSG were treated with deployment of double pigtail plastic stents across orifice leak, positioning one end inside the collection and the other end in remnant stomach. The aim of EID is to internally drain the collection and at the same time promote leak healing.

Results

Double pigtails stent were successfully delivered in 66 out of 67 patients (98.5 %). Fifty patients were cured by EID after a mean time of 57.5 days and an average of 3.14 endoscopic sessions. Two died for event not related to EID. Nine are still under treatment; five failure had been registered. Six patients developed late stenosis treated endoscopically.

Conclusions

EID proved to be a valid, curative, and safe mini-invasive approach for treatment of leaks following SG. EID achieves complete drainage of perigastric collections and stimulates mucosal growth over the stent. EID is well tolerated, allows early re-alimentation, and it is burdened by fewer complications than others technique. Long-term follow-up confirms good outcomes with no motility or feeding alterations.

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Compliance with Ethical Standards

We declare that this article does not contain any studies with human participants or animals performed by any of the authors. Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

Gianfranco DONATELLI: no conflict of interest

Jean-Loup DUMONT: no conflict of interest

Fabrizio CEREATTI: no conflict of interest

Stefano FERRETTI: no conflict of interest

Bertrand Marie Vergeau: no conflict of interest

Thierry TUSZYNSKI: no conflict of interest

Guillaume POURCHER: no conflict of interest

Hadrien TRANCHART: no conflict of interest

Paola MARIANI: no conflict of interest

Alexandre MEDURI:no conflict of interest

Jean-Marc CATHELINE: no conflict of interest

Ibrahim DAGHER: no conflict of interest

Fausto FIOCCA: no conflict of interest

Jean-Pierre MARMUSE: no conflict of interest

Bruno MEDURI: no conflict of interest

The authors have no financial arrangements or commercial associations that might be a conflict of interest in relation to this manuscript.

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Authors and Affiliations

  1. Unité d’Endoscopie Interventionnelle, Générale de Santé, Hôpital Privé des Peupliers, 8 Place de l’Abbé G. Henocque, 75013, Paris, France

    G. Donatelli, J-L. Dumont, B. M. Vergeau, T. Tuszynski, A. Meduri & B. Meduri

  2. Unit of Interventional Endoscopy, Department of General Surgery “P. Stefanini”, “Sapienza” University of Rome, 155 Viale del Policlinico, 00161, Rome, Italy

    G. Donatelli, F. Cereatti, P. Mariani & F. Fiocca

  3. Service de Chirurgie Viscérale, Hôpital Universitaire Antoine Béclère - AP-HP, 157 Rue de la Porte de Trivaux, 92140, Clamart, France

    S. Ferretti, G. Pourcher, H. Tranchart & I. Dagher

  4. Service de Chirurgie Viscérale, Centre Hôspitalier de Saint-Denis, 2 Rue Docteur Delafontaine, 93200, Saint-Denis, France

    J-M. Catheline

  5. Service de Chirurgie Digestive et Viscérale, Hôpital Universitaire Bichat - Claude Bernard - AP-HP, 46 rue Henri Huchard, 75877, Paris, France

    J-P. Marmuse

Authors
  1. G. Donatelli
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  2. J-L. Dumont
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  3. F. Cereatti
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  4. S. Ferretti
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  5. B. M. Vergeau
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  6. T. Tuszynski
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  7. G. Pourcher
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  8. H. Tranchart
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  9. P. Mariani
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  10. A. Meduri
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  11. J-M. Catheline
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  12. I. Dagher
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  13. F. Fiocca
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  14. J-P. Marmuse
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  15. B. Meduri
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Corresponding author

Correspondence to G. Donatelli.

Electronic supplementary material

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Videos 1

Direct endoscopic exploration of peritoneal cavity (NOTES procedure) through a large fistula defect followed sleeve gastrectomy. (MOV 12545 kb)

Videos 2

Granulation tissue formation and watertight closure of large fistula defect at the level of medium gastric line. (MOV 9326 kb)

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Donatelli, G., Dumont, JL., Cereatti, F. et al. Treatment of Leaks Following Sleeve Gastrectomy by Endoscopic Internal Drainage (EID). OBES SURG 25, 1293–1301 (2015). https://doi.org/10.1007/s11695-015-1675-x

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  • DOI: https://doi.org/10.1007/s11695-015-1675-x

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