title: Gastric leak after laparoscopic sleeve gastrectomy: early covered self-expandable stent reduces healing time.
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy has become a very frequent procedure in bariatric surgery due to its efficacy and simplicity compared to gastric bypass. Gastric staple line leak (1 to 7 % of cases) is a severe complication with a long nonstandardized treatment. The aim of this retrospective study was to examine the success and tolerance of covered stents in its management.
  
  
  METHODS
  From January 2009 to December 2011, nine patients with gastric staple line leaks after sleeve gastrectomy were treated with covered stents in our department (seven referred from other institutions). The leaks were diagnosed by CT scan and visualized during the endoscopy. Among the studied variables were operative technique, post-operative fistula diagnosis delay, stent treatment delay, and stent tolerance. In our institution, Hanarostent® (length 17 cm, diameter 18 mm; M.I. Tech, Seoul, Korea) was used and inserted under direct endoscopic control.
  
  
  RESULTS
  Stent treatment was successful in seven cases (78 %). Two other cases had total gastrectomy (405 and 185 days after leak diagnosis). Early stent removal (due to migration or poor tolerance) was necessary in three cases. The average stent treatment duration was of 6.4 weeks, and the average healing time was 141 days. The five patients with an early stent treatment (≤ 3 weeks after leak diagnosis) had an average healing time of 99 days versus 224 for the four others.
  
  
  CONCLUSIONS
  Covered self-expandable stent is an effective treatment of gastric leaks after sleeve gastrectomy. Early stent treatment seems to be associated with shorter healing time.
authors: Paris Nord Obesity Referral Center, Department of Digestive Surgery, Hôpital Louis-Mourier (Assistance Publique des Hôpitaux de Paris), Université Paris 7 Denis-Diderot, 178 rue des Renouillers, 92700, Colombes, France.
authors: F
authors: F
authors: Simon
authors: I
authors: I
authors: Siciliano
authors: A
authors: A
authors: Gillet
authors: B
authors: B
authors: Castel
authors: B
authors: B
authors: Coffin
authors: S
authors: S
authors: Msika
mesh_terms: D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D020878:Device Removal; D004724:Endoscopy; D005260:Female; D005602:France / Q000453:epidemiology; D015391:Gastroplasty / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D017792:Surgical Stapling; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing