Transluminal or Percutaneous Endoscopic Drainage and Debridement of Abscesses After Bariatric Surgery: a Case Series.
OBJECTIVE
Since redo surgery is associated with a high risk of morbidity and mortality after bariatric surgery in case of leakage, we sought to evaluate whether endoscopic drainage and debridement of collections following bariatric surgery is an efficient step-up approach to the management of these complications.


METHODS
From 2007 to 2011, we retrospectively studied our cohort of nine cases treated by endoscopic drainage and debridement of abdominal abscesses secondary to postbariatric surgery leaks performed via the transluminal or percutaneous route.


RESULTS
Three patients were treated by percutaneous endoscopic debridement of abscesses knowing that their leak was already closed by other endoscopic means and that their collection did not improve despite external drain in place. Six patients were treated by transluminal endoscopic drainage to perform necrosectomy as a first-line option or after failure of improvement after endoscopic treatment. The number of sessions required ranged from 1 to 3. Most severe patients had rapid improvement of their hemodynamic and respiratory conditions. In eight of the nine patients, we were able to close the fistula by stent, fistula plugs, or a macroclip. Resolution of collections was seen in seven out of nine patients, but two required further surgery.


CONCLUSIONS
Endoscopic necrosectomy via the transluminal or percutaneous route is a feasible option in postbariatric surgery patients with necrotic abscesses not adequately managed by the classical combination of percutaneous drainage and stenting. Further wide-scale studies are needed to compare this non-surgical method with surgical necrosectomy in postbariatric surgery patients.
Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, ULB (Université Libre de Bruxelles), Erasme Hospital, 808 route de Lennik, 1070, Brussels, Belgium. arnaud.lemmers@erasme.ulb.ac.be.
Arnaud
A
Lemmers
Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, ULB (Université Libre de Bruxelles), Erasme Hospital, 808 route de Lennik, 1070, Brussels, Belgium. damien.tan.m.y@sgh.com.sg.
Damien My
DM
Tan
Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, ULB (Université Libre de Bruxelles), Erasme Hospital, 808 route de Lennik, 1070, Brussels, Belgium. mostafa.ibrahim@webgit.net.
Mostafa
M
Ibrahim
Department of Abdominal Surgery, ULB (Université Libre de Bruxelles), Erasme Hospital, 1070, Brussels, Belgium. patrizia.loi@erasme.ulb.ac.be.
Patrizia
P
Loi
Department of Intensive Care, ULB (Université Libre de Bruxelles), Erasme Hospital, 1070, Brussels, Belgium. ddebacke@ulb.ac.be.
Daniel
D
De Backer
Department of Abdominal Surgery, ULB (Université Libre de Bruxelles), Erasme Hospital, 1070, Brussels, Belgium. jean.closset@erasme.ulb.ac.be.
Jean
J
Closset
Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, ULB (Université Libre de Bruxelles), Erasme Hospital, 808 route de Lennik, 1070, Brussels, Belgium. jacques.deviere@erasme.ulb.ac.be.
Jacques
J
Devière
Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, ULB (Université Libre de Bruxelles), Erasme Hospital, 808 route de Lennik, 1070, Brussels, Belgium. olivier.lemoine@erasme.ulb.ac.be.
Olivier
O
Le Moine
D018784:Abdominal Abscess / Q000209:etiology / Q000628:therapy*; D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects*; D003646:Debridement / Q000379:methods*; D004322:Drainage / Q000379:methods*; D005260:Female; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
Endoscopic necrosectomy; Postoperative collections; RYGBP; Sleeve gastrectomy; Stenting