Elizabeth Long, MD, Osama Abdul-Rahim, MD, Paul Rider, MD, William O Richards, MD, FACS. University of South Alabama
Background: Gastric leaks continue to be a troubling predicament for physicians and patients alike. They are especially concerning after bariatric surgery. Electrolyte abnormalities and dehydration continuously pose a life threatening problem in these patients.
Methods: This is an IRB approved retrospective review of our experience with a biologic tissue mesh plug closure of gastric leaks. Our interventional radiology colleagues percutaneously accessed the perigastric collection with a wire and a straight catheter was guided through the gastric wall defect and advanced over the wire until it was intraluminal. The surgeon then placed an endoscope down to the level of the gastric defect. The wire was then retrieved by the endoscope achieving percutaneo-oral wire access. The biologic tissue matrix was then measured and cut to a square and inverted into a cone like structure with a flat straight piece on the open end. The cone patch was then secured to the wire with 0 braided polyglactin suture loop. The wire was then withdrawn back through the gastric defect pulling the plug and patch into position and placement was confirmed by endoscopy.
Results: We attempted closure of a gastric leak arising after bariatric surgery in six patients. Five underwent successful deployment while one had premature disconnection of the plug from the wire and could not be deployed. The five who had successful deployment had immediate success and within days resumed enteral intake of liquids and resolution of the leak. Two of the six patients additionally underwent covered stent placement to stent a stenotic area at the incisura angularis from the esophagus to the antrum. This stent was typically removed 1-2 weeks later. There were no complications related to the procedure or the plug. Only one patient has undergone repeat endoscopy to evaluate the status of the plug. In that patient an ulcer at the plug site was visualized one month after the procedure. Three months later endoscopy showed the clean ulcer had shrunk to half of the original ulcer size.
Conclusion: This novel minimally invasive technique utilizing IR and endoscopic placement of a biologic mesh plug into gastric leaks after bariatric surgery has been highly successful in treating chronic and subacute gastric leaks. We recommend that these endoscopic techniques be used to close gastric defects prior to operative intervention.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87262
Program Number: P492
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster