Courtney Cripps, MD, Sarah Sabrudin, Mitchell Roslin, MD, FACS. Northwell Health-Lenox Hill Hospital
Introduction: Bariatric surgery has proven efficacy in treating obesity and obesity related conditions such as diabetes. Despite their proven efficacy, complications of these procedures are associated with significant morbidity and are challenging to manage. Therapeutic endoscopy has become essential in the treatment of bariatric surgery complications. This series serves to demonstrate one of the newest and most innovative strategies in the treatment of anastomotic leaks following bariatric surgery.
Methodology: A retrospective review of 4 patients who underwent endoscopic management of a leak following bariatric surgery. Three of 4 patients were transferred for definitive management after failed initial attempts at outside hospitals. One of the 4 patients underwent initial operation at our institution. Two of the patients underwent laparoscopic sleeve gastrectomies, 1 underwent a laparoscopic bypass revision with completion of a duodenal switch, and another underwent a laparoscopic modified duodenal switch. All patients were hemodynamically stable with no evidence of peritonitis. All patients underwent CT evaluation of the abdomen; both patients who underwent sleeve gastrectomies demonstrated proximal gastric remnant leaks, and the patients undergoing duodenal switch operations demonstrated anastomotic leaks. The treatment algorithm of these patients involved immediate endoscopy to ensure the absence of a distal obstruction and at that time were evaluated for internal catheter placement (7 French double pigtail catheter). Three patients underwent immediate internal catheter placement, and the patient who underwent a revision of the gastric bypass with completion of the duodenal switch underwent internal drainage with a 10 French double pigtail catheter prior to downsizing to a 7 French doubt pigtail catheter 21 days after initial placement. All patients were started on a full liquid diet under the guidance of a nutritionist on post-procedural day 2. All patients underwent repeat endoscopy and removal of the internal catheters at a mean of 62 days.
Results: All patients exhibited complete healing of the leak by CT, upper gastrointestinal series or endoscopy at a mean of 62 days post-procedure, and internal drainage catheters were removed at that time.
Conclusion: In hemodynamically stable patients, the treatment options for bariatric surgery leaks are vast. Despite numerous available options, long term success of these interventions remains unknown. As the treatment algorithm continues to develop, internal drainage with a double pigtail catheter should be considered in patients that are hemodynamically stable and those who demonstrate no distal obstruction with cavities amenable to this particular drainage.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80468
Program Number: P477
Presentation Session: Poster (Non CME)
Presentation Type: Poster
