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Fernandez AZ, Luthra AK, Evans JA. Endoscopic closure of persistent gastric leak and fistula following laparoscopic sleeve gastrectomy. Int J Surg Case Rep. 2014;6:186-7doi: 10.1016/j.ijscr.2014.11.077.
Fernandez, A. Z., Luthra, A. K., & Evans, J. A. (2015). Endoscopic closure of persistent gastric leak and fistula following laparoscopic sleeve gastrectomy. International journal of surgery case reports, 6186-7. https://doi.org/10.1016/j.ijscr.2014.11.077
Fernandez, Adolfo Z, et al. "Endoscopic closure of persistent gastric leak and fistula following laparoscopic sleeve gastrectomy." International journal of surgery case reports vol. 6 (2015): 186-7. doi: https://doi.org/10.1016/j.ijscr.2014.11.077
Fernandez AZ, Luthra AK, Evans JA. Endoscopic closure of persistent gastric leak and fistula following laparoscopic sleeve gastrectomy. Int J Surg Case Rep. 2015;6:186-7. doi: 10.1016/j.ijscr.2014.11.077. Epub 2014 Dec 10. PMID: 25544488; PMCID: PMC4347957.
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Int J Surg Case Rep. 2015;6:186-7. doi: 10.1016/j.ijscr.2014.11.077. Epub 2014 Dec 10.

Endoscopic closure of persistent gastric leak and fistula following laparoscopic sleeve gastrectomy.

International journal of surgery case reports

Adolfo Z Fernandez, Anjuli K Luthra, John A Evans

Affiliations

  1. Wake Forest Baptist Medical Center Blvd., Winston-Salem, NC 27157, USA.
  2. Wake Forest Baptist Medical Center Blvd., Winston-Salem, NC 27157, USA. Electronic address: [email protected].

PMID: 25544488 PMCID: PMC4347957 DOI: 10.1016/j.ijscr.2014.11.077

Abstract

INTRODUCTION: Conservative management for gastric leak and fistulae after laparoscopic sleeve gastrectomy (LSG) often results in prolonged hospitalization as well as requirement of TPN or recurrent surgery (Casella et al., 2009) [1]. Endoscopically-placed stents are an additional non-invasive method, but are associated with the complication of stent migration in up to 50% of cases (Casella and co-workers, 2009) [1,4]. As other non-invasive means of treatment are absent, we believe this case demonstrates a new technique for multiple gastric leaks following LSG in patients without sepsis or peritonitis.

PRESENTATION OF CASE: A patient developed a staple line gastric leak that persisted for 10 weeks following LSG despite multiple modalities of treatment. She refused to undergo stent placement, so via esophagogastroduodenoscopy (EGD), fistula margins were cauterized with argon plasma coagulation and a fibrin sealant was injected to include the surrounding area. Endoclips were placed along the fistula tracts. A repeat procedure was required. Follow up imaging confirmed resolution of gastric leak and patient did not experience additional complications.

DISCUSSION: The patient was able to discontinue TPN and return to an oral diet. Both procedures were well tolerated and did not require hospitalization.

CONCLUSION: Endoscopic management of multiple gastric leaks and fistulae using fibrin seal, endoclips, and cauterization appears to be a promising noninvasive form of treatment with a lower associated morbidity and shortened hospitalization.

Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Keywords: Endoclips; Endoscopic closure; Gastric bypass; Gastric leak; Laparoscopic sleeve gastrectomy

References

  1. J Am Coll Surg. 2008 May;206(5):935-8; discussion 938-9 - PubMed
  2. Ann Thorac Surg. 2010 Mar;89(3):931-6; discussion 936-7 - PubMed
  3. Surg Today. 2014 Jul;44(7):1307-12 - PubMed
  4. Obes Surg. 2009 Jul;19(7):821-6 - PubMed
  5. Surg Obes Relat Dis. 2013 Sep-Oct;9(5):816-29 - PubMed

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