Skip to main content
Erschienen in: Obesity Surgery 8/2016

24.12.2015 | Original Contributions

A Specifically Designed Stent for Anastomotic Leaks after Bariatric Surgery: Experiences in a Tertiary Referral Hospital

verfasst von: Martin R. van Wezenbeek, Martine M. de Milliano, Simon W. Nienhuijs, Pieter Friederich, Lennard P. L. Gilissen

Erschienen in: Obesity Surgery | Ausgabe 8/2016

Einloggen, um Zugang zu erhalten

Abstract

Background

The management of anastomotic leakage after either laparoscopic Roux-en-Y gastric bypass (LGBP) or laparoscopic sleeve gastrectomy (LSG) remains a burden. Various options are available for the treatment of these leaks. A newer and less invasive option for the treatment of leaks is the use of endoluminal stents. The main drawback for this treatment is stent migration. The current study describes the outcome of a new, specifically designed stent for the treatment of anastomotic leaks after bariatric surgery.

Methods

For this retrospective observational study, the medical charts of patients undergoing bariatric surgery between October 1, 2010 and July 1, 2013 were reviewed. All patients with anastomotic leakage, treated with the bariatric Hanarostent, were included.

Results

Twelve patients were included out of a total of 1702 bariatric patients in the described period. Seven had a leakage after LSG, five after LGBP. An average of 2.4 endoscopic procedures and 1.25 stents were used per patient. Successful treatment was seen in nine out of 12 patients (75 %). Most common complication was dislocation or migration of the stent, occurring in eight patients (66.7 %).

Conclusions

The ECBB Hanarostent®, which was specifically designed for post bariatric leakages, shows equal but not favorable success rates in this small series compared to previous reports on other types of stenting techniques. Despite the stent design, the complication rate is not reduced and the main future goal should be to target the high stent migration rate.
Literatur
1.
Zurück zum Zitat Ribaric G, Buchwald JN, McGlennon TW. Diabetes and weight in comparative studies of bariatric surgery vs conventional medical therapy: a systematic review and meta-analysis. Obes Surg. 2014;24(3):437–55.CrossRefPubMed Ribaric G, Buchwald JN, McGlennon TW. Diabetes and weight in comparative studies of bariatric surgery vs conventional medical therapy: a systematic review and meta-analysis. Obes Surg. 2014;24(3):437–55.CrossRefPubMed
2.
Zurück zum Zitat Sjostrom L. Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study. Int J Obes. 2008;32 Suppl 7:S93–7.CrossRef Sjostrom L. Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study. Int J Obes. 2008;32 Suppl 7:S93–7.CrossRef
3.
Zurück zum Zitat Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.CrossRefPubMed Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.CrossRefPubMed
4.
Zurück zum Zitat Sanni A, Perez S, Medbery R, et al. Postoperative complications in bariatric surgery using age and BMI stratification: a study using ACS-NSQIP data. Surg Endosc. 2014;28(12):3302–9.CrossRefPubMed Sanni A, Perez S, Medbery R, et al. Postoperative complications in bariatric surgery using age and BMI stratification: a study using ACS-NSQIP data. Surg Endosc. 2014;28(12):3302–9.CrossRefPubMed
5.
Zurück zum Zitat Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26(6):1509–15.CrossRefPubMed Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26(6):1509–15.CrossRefPubMed
6.
Zurück zum Zitat van Rutte PW, Smulders JF, de Zoete JP, et al. Outcome of sleeve gastrectomy as a primary bariatric procedure. Br J Surg. 2014;101(6):661–8.CrossRefPubMed van Rutte PW, Smulders JF, de Zoete JP, et al. Outcome of sleeve gastrectomy as a primary bariatric procedure. Br J Surg. 2014;101(6):661–8.CrossRefPubMed
7.
Zurück zum Zitat Weiner RA, El-Sayes IA, Theodoridou S, et al. Early post-operative complications: incidence, management, and impact on length of hospital stay. A retrospective comparison between laparoscopic gastric bypass and sleeve gastrectomy. Obes Surg. 2013;23(12):2004–12.CrossRefPubMed Weiner RA, El-Sayes IA, Theodoridou S, et al. Early post-operative complications: incidence, management, and impact on length of hospital stay. A retrospective comparison between laparoscopic gastric bypass and sleeve gastrectomy. Obes Surg. 2013;23(12):2004–12.CrossRefPubMed
8.
Zurück zum Zitat Whitlock KA, Gill RS, Ali T, et al. Early outcomes of Roux-en-Y gastric bypass in a publically funded obesity program. ISRN Obes. 2013;2013:296597.PubMedPubMedCentral Whitlock KA, Gill RS, Ali T, et al. Early outcomes of Roux-en-Y gastric bypass in a publically funded obesity program. ISRN Obes. 2013;2013:296597.PubMedPubMedCentral
9.
Zurück zum Zitat Jacobsen HJ, Nergard BJ, Leifsson BG, et al. Management of suspected anastomotic leak after bariatric laparoscopic Roux-en-y gastric bypass. Br J Surg. 2014;101(4):417–23.CrossRefPubMedPubMedCentral Jacobsen HJ, Nergard BJ, Leifsson BG, et al. Management of suspected anastomotic leak after bariatric laparoscopic Roux-en-y gastric bypass. Br J Surg. 2014;101(4):417–23.CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Schiesser M, Kressig P, Bueter M, et al. Successful endoscopic management of gastrointestinal leakages after laparoscopic Roux-en-Y gastric bypass surgery. Dig Surg. 2014;31(1):67–70.CrossRef Schiesser M, Kressig P, Bueter M, et al. Successful endoscopic management of gastrointestinal leakages after laparoscopic Roux-en-Y gastric bypass surgery. Dig Surg. 2014;31(1):67–70.CrossRef
11.
Zurück zum Zitat Simon F, Siciliano I, Gillet A, et al. Gastric leak after laparoscopic sleeve gastrectomy: early covered self-expandable stent reduces healing time. Obes Surg. 2013;23(5):687–92.CrossRefPubMed Simon F, Siciliano I, Gillet A, et al. Gastric leak after laparoscopic sleeve gastrectomy: early covered self-expandable stent reduces healing time. Obes Surg. 2013;23(5):687–92.CrossRefPubMed
12.
Zurück zum Zitat Urschel JD. Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review. Am J Surg. 1995;169(6):634–40.CrossRefPubMed Urschel JD. Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review. Am J Surg. 1995;169(6):634–40.CrossRefPubMed
13.
Zurück zum Zitat van Boeckel PG, Sijbring A, Vleggaar FP, et al. Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus. Aliment Pharmacol Ther. 2011;33(12):1292–301.CrossRefPubMed van Boeckel PG, Sijbring A, Vleggaar FP, et al. Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus. Aliment Pharmacol Ther. 2011;33(12):1292–301.CrossRefPubMed
14.
Zurück zum Zitat Salminen P, Gullichsen R, Laine S. Use of self-expandable metal stents for the treatment of esophageal perforations and anastomotic leaks. Surg Endosc. 2009;23(7):1526–30.CrossRefPubMed Salminen P, Gullichsen R, Laine S. Use of self-expandable metal stents for the treatment of esophageal perforations and anastomotic leaks. Surg Endosc. 2009;23(7):1526–30.CrossRefPubMed
15.
Zurück zum Zitat Puig CA, Waked TM, Baron Sr TH, et al. The role of endoscopic stents in the management of chronic anastomotic and staple line leaks and chronic strictures after bariatric surgery. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2014;10(4):613–7.CrossRef Puig CA, Waked TM, Baron Sr TH, et al. The role of endoscopic stents in the management of chronic anastomotic and staple line leaks and chronic strictures after bariatric surgery. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2014;10(4):613–7.CrossRef
16.
Zurück zum Zitat Victorzon M, Victorzon S, Peromaa-Haavisto P. Fibrin glue and stents in the treatment of gastrojejunal leaks after laparoscopic gastric bypass: a case series and review of the literature. Obes Surg. 2013;23(10):1692–7.CrossRefPubMed Victorzon M, Victorzon S, Peromaa-Haavisto P. Fibrin glue and stents in the treatment of gastrojejunal leaks after laparoscopic gastric bypass: a case series and review of the literature. Obes Surg. 2013;23(10):1692–7.CrossRefPubMed
17.
Zurück zum Zitat Donatelli G, Dhumane P, Perretta S, et al. Endoscopic placement of fully covered self expanding metal stents for management of post-operative foregut leaks. J Minim Access Surg. 2012;8(4):118–24.CrossRefPubMedPubMedCentral Donatelli G, Dhumane P, Perretta S, et al. Endoscopic placement of fully covered self expanding metal stents for management of post-operative foregut leaks. J Minim Access Surg. 2012;8(4):118–24.CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Swinnen J, Eisendrath P, Rigaux J, et al. Self-expandable metal stents for the treatment of benign upper GI leaks and perforations. Gastrointest Endosc. 2011;73(5):890–9.CrossRefPubMed Swinnen J, Eisendrath P, Rigaux J, et al. Self-expandable metal stents for the treatment of benign upper GI leaks and perforations. Gastrointest Endosc. 2011;73(5):890–9.CrossRefPubMed
19.
Zurück zum Zitat Sharaiha RZ, Kim KJ, Singh VK, et al. Endoscopic stenting for benign upper gastrointestinal strictures and leaks. Surg Endosc. 2014;28(1):178–84.CrossRefPubMed Sharaiha RZ, Kim KJ, Singh VK, et al. Endoscopic stenting for benign upper gastrointestinal strictures and leaks. Surg Endosc. 2014;28(1):178–84.CrossRefPubMed
20.
Zurück zum Zitat Choi HJ, Lee BI, Kim JJ, et al. The temporary placement of covered self-expandable metal stents to seal various gastrointestinal leaks after surgery. Gut Liver. 2013;7(1):112–5.CrossRefPubMedPubMedCentral Choi HJ, Lee BI, Kim JJ, et al. The temporary placement of covered self-expandable metal stents to seal various gastrointestinal leaks after surgery. Gut Liver. 2013;7(1):112–5.CrossRefPubMedPubMedCentral
21.
Zurück zum Zitat Leenders BJ, Stronkhorst A, Smulders FJ, et al. Removable and repositionable covered metal self-expandable stents for leaks after upper gastrointestinal surgery: experiences in a tertiary referral hospital. Surg Endosc. 2013;27(8):2751–9.CrossRefPubMed Leenders BJ, Stronkhorst A, Smulders FJ, et al. Removable and repositionable covered metal self-expandable stents for leaks after upper gastrointestinal surgery: experiences in a tertiary referral hospital. Surg Endosc. 2013;27(8):2751–9.CrossRefPubMed
22.
Zurück zum Zitat Coblijn UK, Verveld CJ, van Wagensveld BA, et al. Laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy as revisional procedure after adjustable gastric band—a systematic review. Obes Surg. 2013;23(11):1899–914.CrossRefPubMed Coblijn UK, Verveld CJ, van Wagensveld BA, et al. Laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy as revisional procedure after adjustable gastric band—a systematic review. Obes Surg. 2013;23(11):1899–914.CrossRefPubMed
23.
Zurück zum Zitat Perathoner A, Zitt M, Lanthaler M, et al. Long-term follow-up evaluation of revisional gastric bypass after failed adjustable gastric banding. Surg Endosc. 2013;27(11):4305–12.CrossRefPubMed Perathoner A, Zitt M, Lanthaler M, et al. Long-term follow-up evaluation of revisional gastric bypass after failed adjustable gastric banding. Surg Endosc. 2013;27(11):4305–12.CrossRefPubMed
24.
Zurück zum Zitat Zhang L, Tan WH, Chang R, et al. Perioperative risk and complications of revisional bariatric surgery compared to primary Roux-en-Y gastric bypass. Surg Endosc. 2014. Zhang L, Tan WH, Chang R, et al. Perioperative risk and complications of revisional bariatric surgery compared to primary Roux-en-Y gastric bypass. Surg Endosc. 2014.
25.
Zurück zum Zitat Eisendrath P, Cremer M, Himpens J, et al. Endotherapy including temporary stenting of fistulas of the upper gastrointestinal tract after laparoscopic bariatric surgery. Endoscopy. 2007;39(7):625–30.CrossRefPubMed Eisendrath P, Cremer M, Himpens J, et al. Endotherapy including temporary stenting of fistulas of the upper gastrointestinal tract after laparoscopic bariatric surgery. Endoscopy. 2007;39(7):625–30.CrossRefPubMed
26.
Zurück zum Zitat Eubanks S, Edwards CA, Fearing NM, et al. Use of endoscopic stents to treat anastomotic complications after bariatric surgery. J Am Coll Surg. 2008;206(5):935–8. discussion 8-9.CrossRefPubMed Eubanks S, Edwards CA, Fearing NM, et al. Use of endoscopic stents to treat anastomotic complications after bariatric surgery. J Am Coll Surg. 2008;206(5):935–8. discussion 8-9.CrossRefPubMed
27.
Zurück zum Zitat Puli SR, Spofford IS, Thompson CC. Use of self-expandable stents in the treatment of bariatric surgery leaks: a systematic review and meta-analysis. Gastrointest Endosc. 2012;75(2):287–93.CrossRefPubMed Puli SR, Spofford IS, Thompson CC. Use of self-expandable stents in the treatment of bariatric surgery leaks: a systematic review and meta-analysis. Gastrointest Endosc. 2012;75(2):287–93.CrossRefPubMed
28.
Zurück zum Zitat Salinas A, Baptista A, Santiago E, et al. Self-expandable metal stents to treat gastric leaks. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2006;2(5):570–2.CrossRef Salinas A, Baptista A, Santiago E, et al. Self-expandable metal stents to treat gastric leaks. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2006;2(5):570–2.CrossRef
29.
Zurück zum Zitat Oshiro T, Kasama K, Umezawa A, et al. Successful management of refractory staple line leakage at the esophagogastric junction after a sleeve gastrectomy using the HANAROSTENT. Obes Surg. 2010;20(4):530–4.CrossRefPubMed Oshiro T, Kasama K, Umezawa A, et al. Successful management of refractory staple line leakage at the esophagogastric junction after a sleeve gastrectomy using the HANAROSTENT. Obes Surg. 2010;20(4):530–4.CrossRefPubMed
30.
Zurück zum Zitat Blackmon SH, Santora R, Schwarz P, et al. Utility of removable esophageal covered self-expanding metal stents for leak and fistula management. Ann Thorac Surg. 2010;89(3):931–6. discussion 6-7.CrossRefPubMed Blackmon SH, Santora R, Schwarz P, et al. Utility of removable esophageal covered self-expanding metal stents for leak and fistula management. Ann Thorac Surg. 2010;89(3):931–6. discussion 6-7.CrossRefPubMed
31.
Zurück zum Zitat Uitdehaag MJ, van Hooft JE, Verschuur EM, et al. A fully-covered stent (Alimaxx-E) for the palliation of malignant dysphagia: a prospective follow-up study. Gastrointest Endosc. 2009;70(6):1082–9.CrossRefPubMed Uitdehaag MJ, van Hooft JE, Verschuur EM, et al. A fully-covered stent (Alimaxx-E) for the palliation of malignant dysphagia: a prospective follow-up study. Gastrointest Endosc. 2009;70(6):1082–9.CrossRefPubMed
Metadaten
Titel
A Specifically Designed Stent for Anastomotic Leaks after Bariatric Surgery: Experiences in a Tertiary Referral Hospital
verfasst von
Martin R. van Wezenbeek
Martine M. de Milliano
Simon W. Nienhuijs
Pieter Friederich
Lennard P. L. Gilissen
Publikationsdatum
24.12.2015
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 8/2016
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-015-2027-6

Weitere Artikel der Ausgabe 8/2016

Obesity Surgery 8/2016 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.