title: Use of endoscopic septotomy for the treatment of late staple-line leaks after laparoscopic sleeve gastrectomy.
abstract: BackgroundStaple-line leak following laparoscopic sleeve gastrectomy is a dire adverse event. While the treatment of acute and early leaks is well established, there is still dispute regarding late and chronic leaks. We describe an endoscopic approach combining septotomy and sleeve stricture dilation for treating late/chronic leaks.MethodsTen consecutive patients with late/chronic proximal leaks were treated at our center. The septum separating the sleeve lumen from the perigastric cavity was progressively dissected over several sessions and the downstream stricture was pneumatically dilated. The technical and clinical success rates were evaluated.Results:All ten patients were treated successfully. Eight patients had sleeve strictures that were dilated in conjunction with septotomy. A mean of five sessions over the course of 43 days was needed to complete treatment. In two patients with a small perigastric cavity and no stricture, septotomy was achieved with through-the-scope balloon dilation of the fistula. No adverse events were encountered.ConclusionsSeptotomy accompanied by stricture dilation seems highly effective and safe in late and chronic leaks following sleeve gastrectomy.
authors.affiliation: Obesity Service, Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, affiliated with Sackler School of Medicine, Tel Aviv university, Tel Aviv, Israel.
authors.forename: Mati
authors.initials: M
authors.lastname: Shnell
authors.affiliation: Obesity Service, Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, affiliated with Sackler School of Medicine, Tel Aviv university, Tel Aviv, Israel.
authors.forename: Nathan
authors.initials: N
authors.lastname: Gluck
authors.affiliation: Bariatric Unit, Department of Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Subhi
authors.initials: S
authors.lastname: Abu-Abeid
authors.affiliation: Obesity Service, Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, affiliated with Sackler School of Medicine, Tel Aviv university, Tel Aviv, Israel.
authors.forename: Erwin
authors.initials: E
authors.lastname: Santo
authors.affiliation: Obesity Service, Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, affiliated with Sackler School of Medicine, Tel Aviv university, Tel Aviv, Israel.
authors.forename: Sigal
authors.initials: S
authors.lastname: Fishman
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000209:etiology / Q000601:surgery*; D002908:Chronic Disease; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D004106:Dilatation; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000009:adverse effects; D013997:Time Factors