Marissa Mencio, MD, Steven G Leeds, MD. Baylor University Medical Center at Dallas
Intro: Fistulas, perforations and anastomotic leaks of the entire gastrointestinal tract are a feared complication and carry high morbidity and mortality. Roux-en-y gastric bypass (RYGB) still remains a volume surgery for morbid obesity and carries a 1-3% risk of leak. Endoluminal wound vac (E-Vac) therapy has already been shown to be useful with leaks from sleeve gastrectomy, but it has never been used to heal a RYGB leak.
Methods: A review of a retrospective and prospectively gathered registry approved by the Institutional Review Board for patients that underwent E-Vac therapy from July 2013 to September 2016 was queried. A total of 53 patients were enrolled in the registry. Sixteen patients underwent bariatric surgery. One patient had a leak after RYGB. This patient had failed surgical intervention and self expanding metal stent placement. E-Vac is comprised of a negative pressure internal wound vac connected to an endosponge. This is placed endoscopically into, or adjacent to, the leak site.
Results: The patient is a 40 year old female transferred after leaking from her gastric staple line after RYGB. She underwent surgical intervention with primary closure and did not improve with a persistent leak. An endoscopic stent was placed and she did not improve. E-Vac therapy was started and she healed after 6 weeks and gradually resolved her multi-system organ failure. She underwent a total of 12 endosponge changes with mean interval between endosponge changes of 3 days. Upon secondary intention healing of her leak site, the patient was started on a diet and discharged home.
Conclusion: E-Vac therapy is a feasible option for leak following RYGB and can be used as a rescue modality when other modalities have failed.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79712
Program Number: V058
Presentation Session: Plenary 1
Presentation Type: Video