Malignant Leakage After Sleeve Gastrectomy: Endoscopic and Surgical Approach
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ORIGINAL CONTRIBUTIONS
Malignant Leakage After Sleeve Gastrectomy: Endoscopic and Surgical Approach Robert Caiazzo 1,2 & Camille Marciniak 1,2 & Ninon Wallach 3 & Magalie Devienne 4 & Gregory Baud 1,2 & Jean-Baptiste Cazauran 3 & Eric Kipnis 5 & Julien Branche 6 & Maud Robert 3 & François Pattou 1,2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Gastric leak occurs after sleeve gastrectomy (SG) in 2% of cases. Most staple-line disruptions (SLD) can be successfully treated with first-line endoscopic procedures. Less favorable situations may lead to more complex therapeutic strategies, like conversion to Roux-en-Y gastric bypass (RYGBP). The aim of our study is to predict the factors of endoscopic treatment failure and to assess the safety of conversion to RYGBP. Methods We included all patients treated in two centers of academic excellence (n = 100) between 2013 and 2017 who had a malignant SLD after SG. A “malignant” leakage met one of the following poor prognosis criteria suggested in the literature: unsuccessfully treated by the first-line endoscopic treatment; generalized peritonitis; anatomical anomalies; gastro-cutaneous or gastro-pleural fistula (GCF/GPF); or chronic leaks (> 4 weeks). Results No deaths occurred during the follow-up (20 ± 12 months). The endoscopy reported an anatomically abnormal gastric tube in 35 (35%) patients (stenosis [n = 21 (21%)], twist [n = 9 (9%)], or both [n = 5 (5%)]). We could maintain the SG in place in 92% of cases without stenosis, twist, or GCF/GPF. Conversion to RYGBP due to leakage was necessary in 37 (37%) patients. Stenosis, twist, or GCF/GPF significantly prevented healing in multivariate analysis (respectively: p = 0.020, OR = 0.17, and p < 0.001, OR = 0.07—logistic regression). Conclusion Endoscopy is the treatment of choice for the management of chronic leaks after SG. The association of anatomical anomalies and GCF/GPF should lead to consideration of conversion to RYGBP. Keywords Sleeve gastrectomy . Leakage . Chronic . Management
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04818-4) contains supplementary material, which is available to authorized users. * Robert Caiazzo [email protected] 1
General Endocrine Surgery Department, Lille University Hospital CHU Lille, Lille, France
2
EGID-UMR 1190, Translational Research Laboratory for Diabetes, Lille University, Lille, France
3
Department of Digestive and Bariatric Surgery, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
4
General Surgery Department, Roubaix Hospital, Roubaix, France
5
Intensive Care Unit, Lille University Hospital CHU Lille, Lille, France
6
Gastro Enterology Department, Lille University Hospital CHU Lille, Lille, France
Introduction Bariatric surgery has been gaining acceptance worldwide, and sleeve gastrectomy (SG) has become the most performed technique. SG represented 54% of bariatric procedures in the USA in 2014, a rise from just 3% in 2008 [1, 2]. In Franc
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