Michael C Morris, MD. Lone Star Surgical, P.A.
The most difficult aspect of surgery is undoubtedly complications. Of all complications the gastro-intestinal leak is one of the most feared by patients and surgeons alike. Sleeve gastrectomy represents a simple and effective bariatric operation with few long term consequences and multiple potential conversional options although its leak has earned the reputation as the most refractory and difficult to resolve. Reduced blood supply, high luminal pressures and difficult to access using a conventional transabdominal approach, the sleeve gastrectomy leak has given rise to endoscopic interventions including the self-expanding stenting therapy, dilational, advanced tissue approximating devices, endoscopic suturing etc… Perhaps if any one therapy was highly effective then the remaining wouldn’t necessarily exist.
Introducing the Inflatable Balloon Stent (IBS), a simple plastic device which is used similarly to a common nasogastric tube – well known to most physicians especially surgeons. The functional components of this device are three. Firstly an inflatable plastic stent, at the distal margin with its thin tubing,extending proximally and ending at the inflation port. The body of the inflatable stent is marking with barium to assist in fluoroscopic placement. Secondly the negative pressure apparatus, connected via perforations in the IBS, tubing along the device and ending proximally at its port to be connected to an external source. And lastly, the feeding port which represents a simple feeding tube extending proximally and running along the device ending distal to the IBS thereby allowing for distal enteral feeding.
The IBS is to be placed as a common nasogastric tube at the time of the surgical intervention, endoscopically or fluoroscopically. Once in position, the IBS is inflated effectively diverting the desired section of GI tract from its remaining. Negative pressure is then used to reduce the luminal pressure of the isolated segment aiding its healing. Enteric feeding then may resume distal to the isolated segment to optimize nutritional status. The time length of the intervention would be variable depending on the status of the leak. The patency of the leak could be viewed using thin gastrografin via the ‘negative pressure port’ in a limited and modified tube study using fluoroscopy or deflating the IBS, stopping the suction and allowing for a more conventional upper GI swallow study. Once the leak has healed the device is simple withdrawn and discarded.
This technology appropriately used can not only assist in closing active leaks in a timely, efficient and cost effective manner but could be used in the high risk individual – revision and conversions of the upper GI tract. The lower GI tract including rectum will be the greatest impact of this device potentially avoiding ostomy formation and the impact of ostomies from a healthcare standpoint. Finally, this may be highly instrumental in endoscopic mucosal resections and even keystone in mucosal transplant techniques.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 98736
Program Number: ETP745
Presentation Session: Emerging Technology Poster Session (Non CME)
Presentation Type: Poster