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Erschienen in: Obesity Surgery 10/2013

01.10.2013 | Review Article

Fibrin Glue and Stents in the Treatment of Gastrojejunal Leaks after Laparoscopic Gastric Bypass: A Case Series and Review of the Literature

verfasst von: Mikael Victorzon, Sarita Victorzon, Pipsa Peromaa-Haavisto

Erschienen in: Obesity Surgery | Ausgabe 10/2013

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Abstract

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the most commonly performed bariatric/metabolic operation in Europe. Different treatment options for the management of gastrojejunal (GJ) leaks following LRYGB have been published. We looked at our own experience with GJ leaks after 645 consecutive LRYGB operations and reviewed the literature with focus on the use of fibrin sealant and self-expandable metal stents as treatment options. Patient data were prospectively collected in the hospital’s database for bariatric patients. All patients with confirmed GJ leaks were reviewed. Patients with GJ leaks were actively treated by a combination of laparoscopic drainage and endoscopic fibrin sealant injections and/or stenting. Six patients (0.93 %) have been treated for GJ leaks. All leaks were successfully treated and there was no leak-related mortality. The mean (SD) time for closure of the leaks and length of hospital stay was 19.5 days (6.2) and 23.2 days (3.7). The literature concerning endoscopic treatment options in case of GJ leaks following LRYGB operations is scarce and inconclusive. Immediate and active treatment with a combination of operative and endoscopic treatment options, rather than choosing only one treatment over another, may enhance the recovery process.
Literatur
2.
Zurück zum Zitat Gonzalez R, Nelson LG, Gallagher SF, et al. Anastomotic leaks after laparoscopic gastric bypass. Obes Surg. 2004;14:1299–307.PubMedCrossRef Gonzalez R, Nelson LG, Gallagher SF, et al. Anastomotic leaks after laparoscopic gastric bypass. Obes Surg. 2004;14:1299–307.PubMedCrossRef
3.
Zurück zum Zitat Ballesta C, Berindoague R, Cabrera M, et al. Management of anastomotic leaks after laparoscopic Roux-en-y gastric bypass. Obes Surg. 2008;18:623–30.PubMedCrossRef Ballesta C, Berindoague R, Cabrera M, et al. Management of anastomotic leaks after laparoscopic Roux-en-y gastric bypass. Obes Surg. 2008;18:623–30.PubMedCrossRef
4.
Zurück zum Zitat Brolin RE, Lin JM. Treatment of gastric leaks after Roux-en-y gastric bypass: a paradigm shift. Surg Obes Relat Dis. 2013;9:229–33.PubMedCrossRef Brolin RE, Lin JM. Treatment of gastric leaks after Roux-en-y gastric bypass: a paradigm shift. Surg Obes Relat Dis. 2013;9:229–33.PubMedCrossRef
5.
Zurück zum Zitat Lee S, Carmody B, Wolfe L, et al. Effect of location and speed of diagnosis on anastomotic leak outcomes in 3,828 gastric bypass cases. J Gastrointest Surg. 2007;11:708–13.PubMedCrossRef Lee S, Carmody B, Wolfe L, et al. Effect of location and speed of diagnosis on anastomotic leak outcomes in 3,828 gastric bypass cases. J Gastrointest Surg. 2007;11:708–13.PubMedCrossRef
7.
Zurück zum Zitat Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008;248:189–98.PubMedCrossRef Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008;248:189–98.PubMedCrossRef
8.
Zurück zum Zitat Garcia-Caballero M, Carbajo M, Martinez-Moreno JM, et al. Drain erosion and gastro-jejunal fistula after one-anastomosis gastric bypass: endoscopic occlusion by fibrin sealant. Obes Surg. 2005;15:719–22.PubMedCrossRef Garcia-Caballero M, Carbajo M, Martinez-Moreno JM, et al. Drain erosion and gastro-jejunal fistula after one-anastomosis gastric bypass: endoscopic occlusion by fibrin sealant. Obes Surg. 2005;15:719–22.PubMedCrossRef
9.
Zurück zum Zitat Kowalski C, Kastuar S, Mehta V, et al. Endoscopic injection of fibrin sealant in repair of gastrojejunostomy leak after laparoscopic Roux-en-y gastric bypass. Surg Obes Relat Dis. 2007;3:438–42.PubMedCrossRef Kowalski C, Kastuar S, Mehta V, et al. Endoscopic injection of fibrin sealant in repair of gastrojejunostomy leak after laparoscopic Roux-en-y gastric bypass. Surg Obes Relat Dis. 2007;3:438–42.PubMedCrossRef
10.
Zurück zum Zitat Rots WI, Mokoena T. Successful endoscopic closure of a benign gastrocolonic fistula using human fibrin sealant through gastroscopic approach: a case report and review of the literature. Eur J Gastroenterol Hepatol. 2003;15:1351–6.PubMedCrossRef Rots WI, Mokoena T. Successful endoscopic closure of a benign gastrocolonic fistula using human fibrin sealant through gastroscopic approach: a case report and review of the literature. Eur J Gastroenterol Hepatol. 2003;15:1351–6.PubMedCrossRef
11.
Zurück zum Zitat Truong S, Bohm G, Klinge U, et al. Results after endoscopic treatment of postoperative upper gastrointestinal fistulas and leaks using combined vicryl plug and fibrin glue. Surg Endosc. 2004;18:1105–8.PubMedCrossRef Truong S, Bohm G, Klinge U, et al. Results after endoscopic treatment of postoperative upper gastrointestinal fistulas and leaks using combined vicryl plug and fibrin glue. Surg Endosc. 2004;18:1105–8.PubMedCrossRef
12.
Zurück zum Zitat Bonanomi G, Prince JM, McSteen F, et al. Sealing effect of fibrin glue on the healing of gastrointestinal anastomoses: implications for the endoscopic treatment of leaks. Surg Endosc. 2004;18:1620–4.PubMed Bonanomi G, Prince JM, McSteen F, et al. Sealing effect of fibrin glue on the healing of gastrointestinal anastomoses: implications for the endoscopic treatment of leaks. Surg Endosc. 2004;18:1620–4.PubMed
13.
Zurück zum Zitat Csendes A, Burgos AM, Braghetto I. Classification and management of leaks after gastric bypass for patients with morbid obesity: a prospective study of 60 patients. Obes Surg. 2012;22:855–62.PubMedCrossRef Csendes A, Burgos AM, Braghetto I. Classification and management of leaks after gastric bypass for patients with morbid obesity: a prospective study of 60 patients. Obes Surg. 2012;22:855–62.PubMedCrossRef
14.
Zurück zum Zitat Edwards CA, Bui TP, Astudillo JA, et al. Management of anastomotic leaks after Roux-en-y bypass using self-expanding polyester stents. Surg Obes Relat Dis. 2008;4:594–9. discussion 599–600.PubMedCrossRef Edwards CA, Bui TP, Astudillo JA, et al. Management of anastomotic leaks after Roux-en-y bypass using self-expanding polyester stents. Surg Obes Relat Dis. 2008;4:594–9. discussion 599–600.PubMedCrossRef
15.
Zurück zum Zitat Gumbs AA, Duffy AJ, Bell RL. Management of gastrogastric fistula after laparoscopic Roux-en-y gastric bypass. Surg Obes Relat Dis. 2006;2:117–21.PubMedCrossRef Gumbs AA, Duffy AJ, Bell RL. Management of gastrogastric fistula after laparoscopic Roux-en-y gastric bypass. Surg Obes Relat Dis. 2006;2:117–21.PubMedCrossRef
16.
Zurück zum Zitat Lee MG, Provost DA, Jones DB. Use of fibrin sealant in laparoscopic gastric bypass for the morbidly obese. Obes Surg. 2004;14:1321–6.PubMedCrossRef Lee MG, Provost DA, Jones DB. Use of fibrin sealant in laparoscopic gastric bypass for the morbidly obese. Obes Surg. 2004;14:1321–6.PubMedCrossRef
17.
Zurück zum Zitat Merrifield BF, Lautz D, Thompson CC. Endoscopic repair of gastric leaks after roux-en-y gastric bypass: a less invasive approach. Gastrointest Endosc. 2006;63:710–4.PubMedCrossRef Merrifield BF, Lautz D, Thompson CC. Endoscopic repair of gastric leaks after roux-en-y gastric bypass: a less invasive approach. Gastrointest Endosc. 2006;63:710–4.PubMedCrossRef
18.
Zurück zum Zitat Salinas A, Baptista A, Santiago E, et al. Self-expandable metal stents to treat gastric leaks. Surg Obes Relat Dis. 2006;2:570–2.PubMedCrossRef Salinas A, Baptista A, Santiago E, et al. Self-expandable metal stents to treat gastric leaks. Surg Obes Relat Dis. 2006;2:570–2.PubMedCrossRef
19.
Zurück zum Zitat Silecchia G, Boru CE, Mouiel J, et al. The use of fibrin sealant to prevent major complications following laparoscopic gastric bypass: results of a multicenter, randomized trial. Surg Endosc. 2008;22:2492–7.PubMedCrossRef Silecchia G, Boru CE, Mouiel J, et al. The use of fibrin sealant to prevent major complications following laparoscopic gastric bypass: results of a multicenter, randomized trial. Surg Endosc. 2008;22:2492–7.PubMedCrossRef
20.
Zurück zum Zitat Spyropoulos C, Argentou MI, Petsas T, et al. Management of gastrointestinal leaks after surgery for clinically severe obesity. Surg Obes Relat Dis. 2012;8:609–15.PubMedCrossRef Spyropoulos C, Argentou MI, Petsas T, et al. Management of gastrointestinal leaks after surgery for clinically severe obesity. Surg Obes Relat Dis. 2012;8:609–15.PubMedCrossRef
21.
Zurück zum Zitat Efthimiou E, Al-Sabah S, Sampalis JS, et al. Fibrin sealant associated with increased body temperature and leukocytosis after laparoscopic gastric bypass. Surg Obes Relat Dis. 2010;6:46–9.PubMedCrossRef Efthimiou E, Al-Sabah S, Sampalis JS, et al. Fibrin sealant associated with increased body temperature and leukocytosis after laparoscopic gastric bypass. Surg Obes Relat Dis. 2010;6:46–9.PubMedCrossRef
22.
Zurück zum Zitat Liu CD, Glantz GJ, Livingston EH. Fibrin glue as a sealant for high-risk anastomosis in surgery for morbid obesity. Obes Surg. 2003;13:45–8.PubMedCrossRef Liu CD, Glantz GJ, Livingston EH. Fibrin glue as a sealant for high-risk anastomosis in surgery for morbid obesity. Obes Surg. 2003;13:45–8.PubMedCrossRef
23.
Zurück zum Zitat Sapala JA, Wood MH, Schuhknecht MP. Anastomotic leak prophylaxis using a vapor-heated fibrin sealant: report on 738 gastric bypass patients. Obes Surg. 2004;14:35–42.PubMedCrossRef Sapala JA, Wood MH, Schuhknecht MP. Anastomotic leak prophylaxis using a vapor-heated fibrin sealant: report on 738 gastric bypass patients. Obes Surg. 2004;14:35–42.PubMedCrossRef
24.
Zurück zum Zitat Silecchia G, Boru CE, Mouiel J, et al. Clinical evaluation of fibrin glue in the prevention of anastomotic leak and internal hernia after laparoscopic gastric bypass: preliminary results of a prospective, randomized multicenter trial. Obes Surg. 2006;16:125–31.PubMedCrossRef Silecchia G, Boru CE, Mouiel J, et al. Clinical evaluation of fibrin glue in the prevention of anastomotic leak and internal hernia after laparoscopic gastric bypass: preliminary results of a prospective, randomized multicenter trial. Obes Surg. 2006;16:125–31.PubMedCrossRef
25.
Zurück zum Zitat Ofikwu GI, Sarhan M, Ahmed L. Evicel glue-induced small bowel obstruction after laparoscopic gastric bypass. Surg Laparosc Endosc Percutan Tech. 2013;23:e38–40.PubMedCrossRef Ofikwu GI, Sarhan M, Ahmed L. Evicel glue-induced small bowel obstruction after laparoscopic gastric bypass. Surg Laparosc Endosc Percutan Tech. 2013;23:e38–40.PubMedCrossRef
26.
Zurück zum Zitat Campos JM, Pereira EF, Evangelista LF, et al. Gastrobronchial fistula after sleeve gastrectomy and gastric bypass: endoscopic management and prevention. Obes Surg. 2011;21:1520–9.PubMedCrossRef Campos JM, Pereira EF, Evangelista LF, et al. Gastrobronchial fistula after sleeve gastrectomy and gastric bypass: endoscopic management and prevention. Obes Surg. 2011;21:1520–9.PubMedCrossRef
27.
Zurück zum Zitat Carrodeguas L, Szomstein S, Soto F, et al. Management of gastrogastric fistulas after divided roux-en-y gastric bypass surgery for morbid obesity: analysis of 1,292 consecutive patients and review of literature. Surg Obes Relat Dis. 2005;1:467–74.PubMedCrossRef Carrodeguas L, Szomstein S, Soto F, et al. Management of gastrogastric fistulas after divided roux-en-y gastric bypass surgery for morbid obesity: analysis of 1,292 consecutive patients and review of literature. Surg Obes Relat Dis. 2005;1:467–74.PubMedCrossRef
28.
Zurück zum Zitat Dallal RM, Datta T, Trang A. Repair of acute gastroesophageal leak after laparoscopic gastric bypass using a covered stent. Surg Obes Relat Dis. 2007;3:652–3.PubMedCrossRef Dallal RM, Datta T, Trang A. Repair of acute gastroesophageal leak after laparoscopic gastric bypass using a covered stent. Surg Obes Relat Dis. 2007;3:652–3.PubMedCrossRef
29.
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;39:625–30.PubMedCrossRef 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;39:625–30.PubMedCrossRef
30.
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;206:935–8. discussion 938–939.PubMedCrossRef Eubanks S, Edwards CA, Fearing NM, et al. Use of endoscopic stents to treat anastomotic complications after bariatric surgery. J Am Coll Surg. 2008;206:935–8. discussion 938–939.PubMedCrossRef
31.
32.
Zurück zum Zitat Kriwanek S, Ott N, Ali-Abdullah S, et al. Treatment of gastro-jejunal leakage and fistulization after gastric bypass with coated self-expanding stents. Obes Surg. 2006;16:1669–74.PubMedCrossRef Kriwanek S, Ott N, Ali-Abdullah S, et al. Treatment of gastro-jejunal leakage and fistulization after gastric bypass with coated self-expanding stents. Obes Surg. 2006;16:1669–74.PubMedCrossRef
33.
Zurück zum Zitat Martin-Malagon A, Arteaga-Gonzalez I, Rodriguez-Ballester L, et al. Gastroesophageal junction leak with serious sepsis after gastric bypass: successful treatment with endoscopy-assisted intraluminal esophageal drainage and self-expandable covered metal stent. Obes Surg. 2010;20:240–3.PubMedCrossRef Martin-Malagon A, Arteaga-Gonzalez I, Rodriguez-Ballester L, et al. Gastroesophageal junction leak with serious sepsis after gastric bypass: successful treatment with endoscopy-assisted intraluminal esophageal drainage and self-expandable covered metal stent. Obes Surg. 2010;20:240–3.PubMedCrossRef
34.
Zurück zum Zitat Thaler K. Treatment of leaks and other bariatric complications with endoluminal stents. J Gastrointest Surg. 2009;13:1567–9.PubMedCrossRef Thaler K. Treatment of leaks and other bariatric complications with endoluminal stents. J Gastrointest Surg. 2009;13:1567–9.PubMedCrossRef
35.
Zurück zum Zitat Efthimiou E, Stein L, Szego P, et al. Stent migration causing alimentary limb obstruction necessitating laparotomy and surgical stent extraction. Surg Obes Relat Dis. 2009;5:375–7.PubMedCrossRef Efthimiou E, Stein L, Szego P, et al. Stent migration causing alimentary limb obstruction necessitating laparotomy and surgical stent extraction. Surg Obes Relat Dis. 2009;5:375–7.PubMedCrossRef
36.
Zurück zum Zitat Vilallonga R, Fort JM, Gonzalez O, et al. Endoscopic management of drain inclusion in the gastric pouch after gastrojejunal leakage after laparoscopic Roux-en-y gastric bypass for the treatment of morbid obesity. Diagn Ther Endosc. 2010;2010:891345. doi:10.1155/2010/891345.PubMedCrossRef Vilallonga R, Fort JM, Gonzalez O, et al. Endoscopic management of drain inclusion in the gastric pouch after gastrojejunal leakage after laparoscopic Roux-en-y gastric bypass for the treatment of morbid obesity. Diagn Ther Endosc. 2010;2010:891345. doi:10.​1155/​2010/​891345.PubMedCrossRef
Metadaten
Titel
Fibrin Glue and Stents in the Treatment of Gastrojejunal Leaks after Laparoscopic Gastric Bypass: A Case Series and Review of the Literature
verfasst von
Mikael Victorzon
Sarita Victorzon
Pipsa Peromaa-Haavisto
Publikationsdatum
01.10.2013
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 10/2013
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-013-1048-2

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