Endoscopic Stents (ES) As Definitive Treatment for Postoperative Leaks in Bariatric Surgery

César Muñoz, MD, José Salinas, MD, Camilo Boza, MD, Fernando Crovari, MD, Ricardo Funke, MD, Alejandro Raddatz, MD, Allan Sharp, MD, Alex Escalona, MD, Fernando Pimentel, MD. Digestive Surgery Department, Hospital Clínico P. Universidad Católica de Chile

INTRODUCTION
Obesity surgery is the most effective treatment for severe obesity. However surgery is associated with complications like postoperative leaks. This complication has difficult treatments and can be potentially severe. The endoscopic stent (ES) is a useful tool in the treatment of other complications and diseases in gastrointestinal surgery but the experience in the treatment of postoperative leaks in bariatric surgery is still reduced. Our aim is to present and describe the results in patients with postoperative bariatric surgery leaks managed with ES in a high volume center of bariatric surgery.

METHODS AND PROCEDURES
Design: Descriptive study. Date: From January 2007 to March 2011. Inclusion criteria: All patients with a postoperative bariatric surgery leak with ES as treatment for closure of defect. Maneuver: A retrospective review of clinical files was done for patients with ES treatment for postoperative leaks from bariatric surgery. Measures variables: Biodemographic, weight, antropometric measures, type of surgery, time of postoperative leaks, methods for diagnosis, time since surgery to ES procedure, rate and time to complete resolution of leaks. Statistical analysis: We use descriptive statistical with central tendency measures and dispertion. The Stata 10.0 software was used for this purpose.

RESULTS
Nineteen patients with postoperative leaks have been treated with ES during the study period. Fifty seven percent were femenine with and median age of 35 years. Median BMI was 39,5kg/m2. In 57% the primary procedure was done in our center. The median time from sugerí to leaks diagnosis was 10 days. Sleeve gastrectomy (42%) was the most frequent surgery in which it was necessary to install a ES. Seventy nine percent had undergone a previous surgery for the treatment of leaks. The median time between the first surgery and the time to install the ES was 25 days. Ninety five percent have the ES was the definitive treatment for leaks and one patients have unscheduled removal for spontaneus expulsion. The median time for removal ES was 85 days and only 1 patients required a new ES for a refistulae.

CONCLUSIONS
The ES in the treatment of postoperative leaks after bariatric surgery is an effective treatment, even when the procedure is frequently done late, because other treatment have failed previously. An early use of ES in patients with diagnosis of leak should result in even quickly reassumption of oral feeding in this patients.

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