Endoscopic stenting for laparoscopic sleeve gastrectomy leaks.
OBJECTIVE
Laparoscopic sleeve gastrectomy is a widely accepted and effective bariatric surgery method. The rate of leakage at the staple-line has been reported to be between 1.5 and 5%. Aside from the use of percutaneous drainage, re-laparoscopy, or abdominal sepsis control by laparotomy, endoscopic esophagogastric stent placement is increasingly preferred as a treatment method. Because laparoscopic sleeve gastrectomy is a widely used modality in our hospital, we aimed to evaluate the rate of leaks and the results of stent placements in our patients.


METHODS
Between January 1st2010 and August 31st2014, laparoscopic sleeve gastrectomy was performed on 236 patients by three surgeons. The demographic information and postoperative discharge summaries were collected and analyzed with the permission of the hospital ethics committee. Information about leak treatment management was also collected.


RESULTS
Leaks after laparoscopic sleeve gastrectomy in four patients were stented in the first postoperative month. Short (12 cm) Hanora® (M.I.Tech, Gyeonggi-do, Korea) self-expandable coated stents were placed in two patients, and long (24 cm) Hanora® self-expandable coated stents were placed in the other two. The stents were removed after one month in two patients, two and a half months later in one, and five months later in another patient. The leaks were demonstrated to be healed in all patients after stent removal. Endoscopic stent revision was performed in one patient due to migration of the stent and in another for stent breakage.


CONCLUSIONS
The success rate of treatment of leaks after laparoscopic sleeve gastrectomy by stent placement has been variable in the literature. The success in early stent placement has been shown to be related to physician expertise. According to the results of our patients, we suggest that endoscopic stent placement in the early stage after controlling sepsis is an effective method in the management of leaks.
Clinic of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey.
Mehmet Timuçin
MT
Aydın
Clinic of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey.
Yeşim Özen
YÖ
Alahdab
Clinic of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey.
Orhan
O
Aras
Clinic of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey.
Bora
B
Karip
Clinic of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey.
Ender
E
Onur
Clinic of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey.
Yalın
Y
İşcan
Clinic of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey.
Kemal
K
Memişoğlu
Complications; endoscopic; fistula; laparoscopic sleeve gastrectomy; leak; management; stent