ENDOSCOPIC SEPTOTOMY FOR THE TREATMENT OF LEAK AFTER SLEEVE GASTRECTOMY
Ramon Diaz*, Gerardo Davalos, Leonard K. Welsh, Dana Portenier, Daniel Guerron
Surgery, Duke University, Durham, NC
Background: Leak after sleeve gastrectomy (SG) is one of the most feared postoperative complications due to an often prolonged and complex treatment course. Several endoscopic procedures have been described to treat chronic and recalcitrant leaks. Endoscopic septotomy was first described in 2009 and utilizes pressure equalization of the abscess cavity and gastric lumen by dividing the septum to facilitate preferential drainage into the gastric lumen. This internal drainage can lead to the obliteration of the abscess cavity and ultimate resolution. This report describes our endoscopic treatment experience in patients with chronic gastric leaks after SG.
Methods: Retrospective analysis of five patients with leak after SG that were referred to our center for endoscopic septotomy treatment between January 2016 and September 2018.
Results: Mean patient age was 51 years (range 40-69), mean body mass index at the time of septotomy was 40.5 kg/m2 (Range 30.8-50.7), and four patients were female. Mean time from SG to leak presentation was 15 days and all the leaks were located at the upper third of the sleeve. Mean time from leak presentation to septotomy procedure was 75 days. Two patients had an associated stricture, and all patients were treated with gastric incisura dilatation before septotomy. Mean operative time was 79 minutes (range 55-125). No procedure-related morbidity or mortality occurred; however, two patients required repeat septotomy due to poor clinical improvement. Despite repeat intervention, one patient experienced treatment failure, resulting in total gastrectomy with esophagojejunostomy for definitive management.
Conclusion: The management of leak after SG is challenging. In experienced hands, endoscopic septotomy is feasible, safe and represents an important option to treat chronic and persistent leaks after SG.
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