title: Effect of Early Use of Covered Self-Expandable Endoscopic Stent on the Treatment of Postoperative Stapler Line Leaks.
abstract: BACKGROUND
  Postoperative leaks are a dreaded complication after bariatric surgery (BS). Its treatment is based on nutritional support and sepsis control by antibiotics, collections drainage and/or prosthesis, and/or surgery.
  
  
  OBJECTIVE
  The aim of this study is to report our experience with coated self-expandable endoscopic stents (SEES) for leaks treatment.
  
  
  METHODS
  This study was performed in a University Hospital, (censored).
  
  
  METHODS
  We performed a retrospective analysis of our BS database from January 2007 to December 2013. All patients with leak after BS treated with SEES were included.
  
  
  RESULTS
  We identified 29 patients; 17 (59%) were women, with median age of 37 (19-65) years, and preoperative body mass index of 40 (28.7-56-6) kg/m(2). Nineteen (65.5%) patients had a sleeve gastrectomy and 10 (34.5%) a Roux-en-Y gastric bypass. All patients had a leak in the stapler line. Median time from surgery to leak diagnosis was 7 (1-51) days, and SEES were installed 8 (0-104) days after diagnosis. Twenty-one (72%) patients also had abdominal exploration. Median length of SEES use was 60 (1-299) days. Patients who had SEES as primary treatment (with or without simultaneous reoperation) had a shorter leak closure time (50 [6-112] vs 109 [60-352] days; p = 0.008). Twenty-eight (96.5%) patients successfully achieved leak closure with SEES. There were 16 migrations in 10 (34%) patients, 1 (3%) stent fracture, 1 opening of the blind end of alimentary limb (3%), and 5 patients (17%) required a second stent due to leak persistence.
  
  
  CONCLUSIONS
  SEES is a feasible, safe, and effective management of post BS leaks, although patients may also require prosthesis revision and abdominal exploration. Primary SEES placement is associated with a shorter leak resolution time.
authors.affiliation: Department of Digestive Surgery. School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, patio interior, División de Cirugía, Región Metropolitana, Santiago, Chile, nfquezada@gmail.com.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Quezada
authors.forename: Cristóbal
authors.initials: C
authors.lastname: Maiz
authors.forename: David
authors.initials: D
authors.lastname: Daroch
authors.forename: Ricardo
authors.initials: R
authors.lastname: Funke
authors.forename: Allan
authors.initials: A
authors.lastname: Sharp
authors.forename: Camilo
authors.initials: C
authors.lastname: Boza
authors.forename: Fernando
authors.initials: F
authors.lastname: Pimentel
mesh_terms: D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000453:epidemiology / Q000601:surgery*; D050110:Bariatric Surgery / Q000009:adverse effects / Q000295:instrumentation; D015992:Body Mass Index; D004322:Drainage; D061345:Early Medical Intervention / Q000379:methods* / Q000706:statistics & numerical data; D016099:Endoscopy, Gastrointestinal / Q000295:instrumentation / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D011184:Postoperative Period; D012086:Reoperation; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents / Q000009:adverse effects; D017792:Surgical Stapling / Q000009:adverse effects* / Q000379:methods; D055815:Young Adult
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