title: Successful management of refractory staple line leakage at the esophagogastric junction after a sleeve gastrectomy using the HANAROSTENT.
abstract: The esophagogastric junction (EGJ) is a potential site of leakage after a sleeve gastrectomy which is usually difficult to treat conservatively. Two patients underwent a laparoscopic sleeve gastrectomy. A subphrenic abscess due to a staple line leakage was detected by CT at 3 weeks and 10 days after the operation, respectively. The abscess was drained laparoscopically. Intractable leakage required several endoscopic treatments, including clipping and sealing. However, a persisting fistula was found on radiographic studies. A covered self-expandable and retrievable stent (HANAROSTENT) was finally placed over the leakage site at 15 and 6 weeks after the reoperation, respectively. Oral intake was achieved from poststent day 1, and they were discharged 2 weeks after stenting. Three months later, the stent was endoscopically removed and the leakage was successfully sealed. The HANAROSTENT is therefore considered to be a safe and effective therapeutic option for the management of staple line leakage at the EGJ.
authors.affiliation: Minimally Invasive Surgery Center, Yotsuya Medical Cube, Tokyo, Japan. t-oshiro@dc5.so-net.ne.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Oshiro
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kasama
authors.forename: Akiko
authors.initials: A
authors.lastname: Umezawa
authors.forename: Eiji
authors.initials: E
authors.lastname: Kanehira
authors.forename: Yoshimochi
authors.initials: Y
authors.lastname: Kurokawa
mesh_terms: D000328:Adult; D004943:Esophagogastric Junction; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D017792:Surgical Stapling / Q000009:adverse effects*; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000601:surgery*