title: An endoscopic strategy for management of anastomotic complications from bariatric surgery: a prospective study.
abstract: BACKGROUND
  Treatment of anastomotic fistulas after bariatric surgery is difficult, and they are often associated with additional surgery, sepsis, and prolonged non-oral feeding.
  
  
  OBJECTIVE
  To assess a new, totally endoscopic strategy to manage anastomotic fistulas.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Tertiary-care university hospital.
  
  
  METHODS
  This study involved 27 consecutive patients from July 2007 to December 2009.
  
  
  METHODS
  This strategy involved successive procedures for endoscopic drainage of the residual cavity, diversion of the fistula with a stent, and then closure of the residual orifice with surgical clips or sealant.
  
  
  METHODS
  Technical success, mortality and morbidity, migration of the stent.
  
  
  RESULTS
  Multiple or complex fistulas were present in 16 cases (59%). Endoscopic drainage (nasal-fistula drain or necrosectomy) was used in 19 cases (70%). Diversion by a covered colorectal stent was used in 22 patients (81%). To close the residual or initial opening, wound clips and glue (cyanoacrylate) were used in 15 cases (55%). Neither mortality nor severe morbidity occurred. Migration of the stent occurred in 13 cases (59%) and was treated by replacement with either a longer stent or with 2 nested stents. The mean time until resolution of fistula was 86 days from the start of endoscopic management, with a mean of 4.4 endoscopies per patient.
  
  
  CONCLUSIONS
  Moderate sample size, nonrandomized study.
  
  
  CONCLUSIONS
  An entirely endoscopic approach to the management of anastomosing fistulas that develop after bariatric surgery--using sequential drainage, sutures, and diversion by stents--achieved resolution of the fistulas with minimal morbidity.
authors.affiliation: Department of Gastroenterology and Hepatology, North Hospital, Marseille, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Bège
authors.forename: Olivier
authors.initials: O
authors.lastname: Emungania
authors.forename: Véronique
authors.initials: V
authors.lastname: Vitton
authors.forename: Philippe
authors.initials: P
authors.lastname: Ah-Soune
authors.forename: David
authors.initials: D
authors.lastname: Nocca
authors.forename: Patrick
authors.initials: P
authors.lastname: Noël
authors.forename: Sarah
authors.initials: S
authors.lastname: Bradjanian
authors.forename: Stéphane V
authors.initials: SV
authors.lastname: Berdah
authors.forename: Christian
authors.initials: C
authors.lastname: Brunet
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Grimaud
authors.forename: Marc
authors.initials: M
authors.lastname: Barthet
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000209:etiology / Q000601:surgery*; D050110:Bariatric Surgery / Q000009:adverse effects*; D016099:Endoscopy, Gastrointestinal / Q000592:standards*; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult