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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   Pages 1 - 6 ( 6 )

Abstract:


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

Objective: To assess the efficacy and safety of specifically designed large covered metal stents for the management 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 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% vs 27%, p=0.018).

Conclusions: 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.

Affiliation:

Unit of Digestive Endoscopy, San Paolo Hospital, Via A. Di Rudiní, 8, 20142 Milano, Unit of Digestive Endoscopy, San Paolo Hospital, Via A. Di Rudiní, 8, 20142 Milano, Gastroenterology and Endoscopy Unit, Department of Medical and Surgical Sciences, S. Orsola University Hospital, Via G. Massarenti, 9, 40138 Bologna, Unit of Hepatobiliopancreatic and Digestive Surgery, Department of Surgery, San Paolo Hospital, University of Milan, Via A. Di Rudiní, 8, 20142 Milano, Unit of Hepatobiliopancreatic and Digestive Surgery, Department of Surgery, San Paolo Hospital, University of Milan, Via A. Di Rudiní, 8, 20142 Milano, Unit of Hepatobiliopancreatic and Digestive Surgery, Department of Surgery, San Paolo Hospital, University of Milan, Via A. Di Rudiní, 8, 20142 Milano, Unit of Hepatobiliopancreatic and Digestive Surgery, Department of Surgery, San Paolo Hospital, University of Milan, Via A. Di Rudiní, 8, 20142 Milano, Unit of Digestive Endoscopy, San Paolo Hospital, Via A. Di Rudiní, 8, 20142 Milano, Unit of Digestive Endoscopy, San Paolo Hospital, Via A. Di Rudiní, 8, 20142 Milano, Unit of Digestive Endoscopy, University of Messina, Hospital “G. Martino”, Via Consolare Valeria 2 - 98124 Messina, Unit of Digestive Endoscopy, University of Messina, Hospital “G. Martino”, Via Consolare Valeria 2 - 98124 Messina, Unit of Gastroenterology and Digestive Endoscopy, ARNAS Garibaldi, 95122 Catania, Department of Health Sciences, University "Magna Graecia", Viale Europa - 88100 Catanzaro, Unit of Digestive Endoscopy, University of Messina, Hospital “G. Martino”, Via Consolare Valeria 2 - 98124 Messina, Unit of Digestive Endoscopy, University of Messina, Hospital “G. Martino”, Via Consolare Valeria 2 - 98124 Messina



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