title: Double Pigtail Stent Insertion for Healing of Leaks Following Roux-en-Y Gastric Bypass. Our Experience (with Videos).
abstract: Roux-en-Y gastric bypass (RYGB) is complicated by a leak in 0-4.3% of cases. Treatment by fully covered stents has been reported to be associated with some life-threatening complications. We report our experience of insertion of double pigtail stents.
  
  
  
  Thirty-three patients (20M, 43 years-20/65), presenting with a leak at an average of 10 days after RYGB (4-35), were treated by double pigtail stent insertion and a nasojejunal feeding tube. Sixty percent of these patients had undergone surgical drainage prior to stenting for control of sepsis. Thirty leaks were located at the top of staple line and three at the gastro-jejunal anastomosis. At a 4-weekly follow-up, ablation or re-stenting was performed depending on status of fistula closure and patients were placed on normal diet.
  
  
  
  At the first follow-up, 10/33 fistulae healed, one patient presented with clinical failure (3%) and needed surgery, and 22/33were re-stented. Twenty-one out of these 22 developed a secondary sub-clinical gastro-gastric fistula and one, instead, developed complex (gastro-gastric, gastro-colic) fistula. All (22) primary fistulae healed following four more weeks of treatment. Average treatment duration was of 61 days (28-99). Thirty-two patients (97%) at a follow-up of 1-33 months are asymptomatic.
  
  
  
  Leaks following RYGB can be successfully and safely managed by double pigtail stents. Upper gastric staple line leaks are responsible for the formation of a secondary sub-clinic gastro-gastric fistula which needs no additional treatment.
authors.affiliation: Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, 75013, Paris, France. donatelligianfranco@gmail.com.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Donatelli
authors.affiliation: Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, 75013, Paris, France.
authors.forename: Jean-Loup
authors.initials: JL
authors.lastname: Dumont
authors.affiliation: Department of General and Laparoscopic Surgery, Lilavati Hospital and Research Center, Bandra (w), Mumbai, India.
authors.forename: Parag
authors.initials: P
authors.lastname: Dhumane
authors.affiliation: Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, 75013, Paris, France.
authors.forename: Stavros
authors.initials: S
authors.lastname: Dritsas
authors.affiliation: Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, 75013, Paris, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Tuszynski
authors.affiliation: Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, 75013, Paris, France.
authors.forename: Bertrand Marie
authors.initials: BM
authors.lastname: Vergeau
authors.affiliation: Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, 75013, Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Meduri
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000209:etiology / Q000601:surgery; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D005747:Gastric Fistula / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D012086:Reoperation / Q000193:education / Q000295:instrumentation / Q000379:methods; D015607:Stents; D014741:Video Recording
keywords: Bariatric surgery; Endoscopic internal drainage; Gastric leak; Pigtail stent; Roux-en-Y gastric bypass (RYGB); Surgical obesity complications