Treatment of gastric leaks with coated self-expanding stents after sleeve gastrectomy.
BACKGROUND
Duodenal switch (DS) is one of the most effective techniques for the treatment of morbid obesity and its co-morbidities, with mortality rate <1%, but with 9.4% morbidity rates (6.5% due to leaks). In our experience, leaks of the staple-line after sleeve gastrectomy (SG) are the most frequent sites of fistula formation and conservative treatment usually takes a long time. We present our experience in the treatment of gastric leaks with coated self-expandable stents (CSES).


METHODS
6 patients had gastric leaks at the gastroesophageal (GE) junction after SG or DS. One patient had a symptomatic gastro-bronchial fistula. Stents were placed by the interventional radiologist under fluoroscopic control and removed endoscopically. In one case, we used an uncoated Wallstent. In two patients, percutaneous microcoil embolization of the fistula was added.


RESULTS
The patient treated with the Wallstent required a total gastrectomy 6 months after placement of the uncovered stent. In the other 5 patients, coated stents were successfully removed and the gastric leaks completely sealed.


CONCLUSIONS
CSES are proposed as an alternative therapeutic option for the management of GE junction leaks in bariatric surgery with good results in terms of morbidity and survival.
Serra
Carlos
C
General Surgery Service, Interventional Radiology, Virgen de los Lirios Hospital, Alcoy, Alicante, Spain. serra_car@gva.es
Baltasar
Aniceto
A
Andreo
Luis
L
Pérez
Nieves
N
Bou
Rafael
R
Bengochea
Marcelo
M
Chisbert
Juan José
JJ
D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000379:methods; D004867:Equipment Design; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D015607:Stents