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https://doi.org/10.1007/s11695-018-3193-0
VIDEO SUBMISSION
Abstract
Introduction Proximal gastric leak is one of the most common complications after laparoscopic sleeve gastrectomy (LSG).
Endoscopy is the gold standard treatment for acute staple-line leaks. Surgery is the most effective treatment modality in case
of chronic fistula.
Material and Methods A 55-year- old man presented an acute leak after LSG. The leak was treated with metal stent deployment
with temporary closure. After 6 months, he presented leak recurrence with general sepsis, perigastric-infected collection, and
gastro-jejunal fistula.
Results Endoscopic internal drainage (EID) was performed; however, due to fistula persistence, a surgical procedure was
proposed. The patient refused revisional surgery; therefore, endoscopic salvage procedure was decided. A fully covered metal
stent was deployed in order to bypass the perigastric collection creating an endoscopic gastro-jejunal anastomosis.
Conclusion Revisional surgery is the gold standard treatment for chronic fistula after SG. Endoscopic treatment with SEMS deploy-
ment may be a sound option in selected cases especially after failure of other endoscopic techniques or refusal of revisional surgery.
Keywords Sleeve gastrectomy . Leak . Fistula . EID . SEMS . Complications . By-pass . Fistula-jejunostomy
Introduction
fistula sealing was achieved. After 6 months, the patient de- jejunostomy has been proposed as an effective and less inva-
veloped diffuse peritonitis and sepsis requiring hospital ad- sive option compared to total gastrectomy [7]. Endoscopic
mission. At a local hospital, there was no availability of inter- fistula-jejunostomy by by-passing the fistula with insertion
ventional radiology; therefore, surgical procedure was per- of fully covered SEMS, as we show in this case, could be
formed. At laparotomy, chronic gastric leak with concomitant considered a viable option in well selected patients especially
infected abscess was highlighted, and a surgical drainage was when other endoscopic treatments fail or surgery is refused.
deployed close to staple line.
Three days from surgery, endoscopic internal drain- Compliance with Ethical Standards
age (EID) with insertion of double-pigtail stents across
the leak was performed [4]. Endoscopic internal drain- This study is in accordance with the ethical standards as laid down in the
1964 Declaration of Helsinki and its later amendments or comparable
age allowed early drain removal and promoted partial
ethical standards.
healing of the abscess cavity.
Conflict of Interest The authors declare that they have no conflict of
interest.
Results
Informed Consent Informed consent was obtained from all individual
participants included in the study.
Nonetheless endoscopic treatment, perigastric collection and a
gastro-jejunal fistula were highlighted at contrast medium
opacification. Gastro-jejunal fistula formation was most prob-
ably related to persistent perigastric collection and on-going
infection. Septotomy [5] was then considered as a viable op- References
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