Andrew R Luhrs, MD, A. Daniel Guerron, MD, Dana Portenier, MD. Duke University Health System
Background: Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure world-wide, consisting of nearly 50% of all procedures performed1. Despite increased adoption and utilization of LSG, staple line leak (SLL) remains a troublesome complication with significant morbidity and mortality. SLL has a reported incidence of 1.0-2.4%2,3. Management of SLL after LSG has continuously evolved and no clear consensus exists on optimal management strategies. Numerous means of endoscopic management of SLL after LSG have been described including self-expanding metal stents, glues, metal clips and endobiliary stents. Here we present a novel technique for the management of SLL after LSG.
Methods: The patient presented to our facility from an outside hospital with a large mid-body SLL. Using a previously placed percutaneous drain a wire was passed through the drain and ensnared by an endoscopic snare. The snare, wire and drain were then externalized through the percutaneous drain tract. The endoscopic snare was then used to capture a t-tube which was then delivered transgastric into the lumen of the stomach. This allowed for internal and external drainage as well as tract formation around the drain. The drain and SLL were then excluded with a self-expanding metal stent.
Results: The patient progressed well post procedurally and had resolution of his previously documented SLL as documented by axial imaging and upper gastrointestinal contrast study after an interval of three weeks.
Conclusion: Endoscopic placement of T-tube and self-expanding metal stent is a viable and effective means of managing SLL after LSG poorly controlled by other means.
1. Angrisani L, et al. Bariatric Surgery and Endoluminal Procedures: IFSO Worldwide Survey 2014. Obes Surg 2017; 27(9):2279-89.
2. Sarkhosh K, Birch DW, Sharma A, et al. Complications assiciated with laparoscpic sleeve gastrectomy for morbid obesity: a surgeon's guide. Can J Surg. 2013; 56(5): 347-52.
3. Noel P, Nedelcu M, Gagner M. Impact of the Surgical Experience on Leak Rate After Laparoscopic Sleeve Gastrectomy. Obes Surg. 2016; 26(8):1782-7.
4. Southwell T, Lim TH, Orga R. Endoscopic Therapy for Treatment of Staple Line Leaks Post-Laparoscopic Sleeve Gastrectomy (LSG): Experience from a Large Bariatric Surgery Centre in New Zealand. Obes Surg. 2016; 26: 1155-62.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94125
Program Number: V057
Presentation Session: Exhibit Hall Theater Video Session II
Presentation Type: EHVideo