title: Fibrin glue and stents in the treatment of gastrojejunal leaks after laparoscopic gastric bypass: a case series and review of the literature.
abstract: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the most commonly performed bariatric/metabolic operation in Europe. Different treatment options for the management of gastrojejunal (GJ) leaks following LRYGB have been published. We looked at our own experience with GJ leaks after 645 consecutive LRYGB operations and reviewed the literature with focus on the use of fibrin sealant and self-expandable metal stents as treatment options. Patient data were prospectively collected in the hospital's database for bariatric patients. All patients with confirmed GJ leaks were reviewed. Patients with GJ leaks were actively treated by a combination of laparoscopic drainage and endoscopic fibrin sealant injections and/or stenting. Six patients (0.93%) have been treated for GJ leaks. All leaks were successfully treated and there was no leak-related mortality. The mean (SD) time for closure of the leaks and length of hospital stay was 19.5 days (6.2) and 23.2 days (3.7). The literature concerning endoscopic treatment options in case of GJ leaks following LRYGB operations is scarce and inconclusive. Immediate and active treatment with a combination of operative and endoscopic treatment options, rather than choosing only one treatment over another, may enhance the recovery process.
authors.affiliation: Department of Gastrointestinal Surgery, Vaasa Central Hospital, Hietalahdenkatu 2-4, 65130, Vasa, Finland, mikael.victorzon@vshp.fi.
authors.forename: Mikael
authors.initials: M
authors.lastname: Victorzon
authors.forename: Sarita
authors.initials: S
authors.lastname: Victorzon
authors.forename: Pipsa
authors.initials: P
authors.lastname: Peromaa-Haavisto
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D004322:Drainage; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications; D015607:Stents; D013270:Stomach / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D015718:Fibrin Tissue Adhesive
references.citation: Surg Obes Relat Dis. 2013 Mar-Apr;9(2):229-33
references.pmid: 22336493
references.citation: Obes Surg. 2013 Apr;23(4):427-36
references.pmid: 23338049
references.citation: Surg Obes Relat Dis. 2006 Mar-Apr;2(2):117-21
references.pmid: 16925334
references.citation: Obes Surg. 2005 May;15(5):719-22
references.pmid: 15946469
references.citation: Surg Obes Relat Dis. 2013 Jul-Aug;9(4):554-8
references.pmid: 22543198
references.citation: Surg Obes Relat Dis. 2010 Jan-Feb;6(1):46-9
references.pmid: 19540171
references.citation: Surg Endosc. 2008 Nov;22(11):2492-7
references.pmid: 18365278
references.citation: Obes Surg. 2012 Jun;22(6):855-62
references.pmid: 22438218
references.citation: Surg Obes Relat Dis. 2012 Sep-Oct;8(5):609-15
references.pmid: 21616725
references.citation: Obes Surg. 2004 Nov-Dec;14(10):1299-307
references.pmid: 15603642
references.citation: Diagn Ther Endosc. 2010;2010:891345
references.pmid: 20634928
references.citation: Endoscopy. 2007 Jul;39(7):625-30
references.pmid: 17611917
references.citation: Surg Obes Relat Dis. 2007 Nov-Dec;3(6):652-3
references.pmid: 17950042
references.citation: Surg Obes Relat Dis. 2007 Jul-Aug;3(4):438-42
references.pmid: 17544924
references.citation: Surg Obes Relat Dis. 2009 May-Jun;5(3):375-7
references.pmid: 18848509
references.citation: J Am Coll Surg. 2008 May;206(5):935-8; discussion 938-9
references.pmid: 18471727
references.citation: Obes Surg. 2010 Feb;20(2):240-3
references.pmid: 19784706
references.citation: Obes Surg. 2008 Jun;18(6):623-30
references.pmid: 18392906
references.citation: Eur J Gastroenterol Hepatol. 2003 Dec;15(12):1351-6
references.pmid: 14624159
references.citation: Obes Surg. 2003 Feb;13(1):45-8
references.pmid: 12630612
references.citation: Surg Endosc. 2004 Nov;18(11):1620-4
references.pmid: 15931477
references.citation: Obes Surg. 2006 Dec;16(12):1669-74
references.pmid: 17217645
references.citation: Obes Surg. 2004 Nov-Dec;14(10):1321-6
references.pmid: 15603645
references.citation: Obes Surg. 2006 Feb;16(2):125-31
references.pmid: 16469211
references.citation: Surg Obes Relat Dis. 2008 Sep-Oct;4(5):594-9; discussion 599-600
references.pmid: 18722820
references.citation: Obes Surg. 2004 Jan;14(1):35-42
references.pmid: 14980031
references.citation: Surg Endosc. 2004 Jul;18(7):1105-8
references.pmid: 15156390
references.citation: J Gastrointest Surg. 2007 Jun;11(6):708-13
references.pmid: 17562118
references.citation: Obes Surg. 2011 Oct;21(10):1520-9
references.pmid: 21643779
references.citation: Ann Surg. 2008 Aug;248(2):189-98
references.pmid: 18650627
references.citation: Surg Obes Relat Dis. 2005 Sep-Oct;1(5):467-74
references.pmid: 16925272
references.citation: J Gastrointest Surg. 2009 Sep;13(9):1567-9
references.pmid: 19319611
references.citation: Gastrointest Endosc. 2006 Apr;63(4):710-4
references.pmid: 16564884
references.citation: Surg Laparosc Endosc Percutan Tech. 2013 Feb;23(1):e38-40
references.pmid: 23386172
references.citation: Surg Obes Relat Dis. 2006 Sep-Oct;2(5):570-2
references.pmid: 17015217
references.citation: Br J Surg. 2005 Jan;92(1):3-4
references.pmid: 15635603