Vamsi V Alli1, Andrew T Strong, MD2, Matthew T Allemang, MD2, Matthew Kroh, MD2, Eric M Pauli, MD1. 1Penn State – Milton S. Hershey Medical Center, 2Cleveland Clinic Foundation
Introduction: Endoscopic management of bariatric surgical complications is commonplace, including the management of leaks and fistulae. Large or complex full-thickness gastrointestinal (GI) tract defects often require multisession or multimodal therapy for closure. The challenges of this environment limit the utility of any single method for endoscopic closure. This abstract reports the results of bariatric surgical complications managed utilizing a novel technique combining endoscopic suturing and clipping.
Methods: A multicenter retrospective study of patients with full thickness GI tract defects following bariatric surgery. The study sites were two tertiary care academic medical centers. Patients were identified who underwent placement of an Ovesco clip (Tubingen, Germany) on top of a GI tract defect closure using the Overstitch device (Apollo Endosurgery, Austin). This Ovesco-Over-Overstitch (OOO) method was utilized in combination with standard endoscopic adjunct maneuvers such as mucosal ablation. Procedures were performed by two experienced surgeon-endoscopists.
Results: Ten patients were identified (8 female, mean age of 52 years, mean body mass index of 41 kg/m2); 8 symptomatic gastro-gastric fistula (mean fistula size of 1.6 cm) following gastric bypass, 1 sleeve gastrectomy leak, 1 gastro-plural fistula. Eight patients underwent OOO in a single session (mean procedure time 99 min). There were two recoverable operative complications (1 suture pull-through, 1 device entanglement) but no post-procedure morbidity. During follow-up (mean 333 days), there were 8 failed closures (80%), with a mean time to failure of 217 days. Four failures were ultimately managed surgically, 3 endoscopically, and 1 remained asymptomatic (excluded from consideration for reintervention).
Discussion: The OOO method led to an overall success rate of 40% for defect closure, with primary efficacy of 20% and an additional 20% rate of salvage with endoscopic therapy. Sixty percent of patients in this series therefore avoided a complex surgical revision. Downsizing a large defect via Overstitch and further securing the closure using an Ovesco clip is a viable technique for managing large full-thickness GI tract defects otherwise not be amenable to endoscopic closure.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88457
Program Number: P375
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster