Yael Marks, MD, Julio Teixeira, MD. Lenox Hill Hospital
Introduction: Although endoscopic stenting for leaks after sleeve gastrectomy can often be easily accomplished by fluoroscopic guidance, anatomoy, strictures, adhesions and other factors can significantly impact the ease and efficiency of stent placement. This video demonstrates alternative techniques of endoscopic stent placenement in complex situations including fluoroscopic assisted, endoscopically assisted and laparoscopically assisted techniques. The following three cases demonstrate specific situations where alternative approaches need to be considered.
Content: The first segment depicts a 40 year old female status post vertical sleeve gastrectomy presented with dysphagia three weeks post-operatively. An UGI showed proximal sleeve dilation with distal narrowing and substantial delayed emptying into the duodenum. A stent was placed using fluoroscopic guidance.
The second segment shows a 62 year old male with a BMI of 55 who underwent lap band placement in 2010, lap band removal in 2012, sleeve gastrectomy in 2014 which was complicated by postoperative leak was treated with stenting. The leak did not resolve with stenting and a second stent was placed under endoscopic guidance.
The final segment depicts laparoscopic stent placement in a 40 female status post vertical sleeve gastrectomy presents with dysphagia six weeks post-operatively. EGD demonstrated extrinsic compression and attempts at fluoroscopic guided stent placement were unsuccessful. Laparoscopic guided stent placement was successful.
Conclusion: Non-operative management of sleeve gastrectomy leaks and extrinsic compression has become increasingly accepted with the advanced placement of gastric stents. If one modality can not be achieved a second modality, with better visualization, such as fluoroscopic assisted, endoscopic assisted or laparoscopic assisted techniques should be considered.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 85437
Program Number: V088
Presentation Session: Thursday Exhibit Hall Theater (Non CME)
Presentation Type: EHVideo