Staple Line Leaks Following Laparoscopic Sleeve Gastrectomy: Low Efficacy of the Over-the-Scope Clip
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Staple Line Leaks Following Laparoscopic Sleeve Gastrectomy: Low Efficacy of the Over-the-Scope Clip Ido Mizrahi 1,2 & Ronit Grinbaum 1 & Ram Elazary 1 & Tzlil Mordechay-Heyn 1 & Noam Kahahna 1 & Julia Epshtein 3 & Harold Jacob 3 & Nahum Beglaibter 1 Received: 23 May 2020 / Revised: 1 October 2020 / Accepted: 6 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose The over-the-scope clip (OTSC) enables non-surgical management of gastrointestinal defects. The aim of this study was to report our experience with OTSC for patients with staple line leaks following laparoscopic sleeve gastrectomy (LSG). Materials and Methods A prospectively maintained IRB-approved institutional database was queried for all patients treated with OTSC for staple line leaks following LSG from 2010 to 2018. Primary outcome was complete resolution of leak following OTSC. Secondary outcome was the number of additional procedures needed following OTSC. Results Twenty-six patients (13 males, 13 females) were treated with OTSC for staple line leaks following LSG. The median age was 35 years (range 18–62), and mean body mass index was 44 kg/m2. The median time from index operation to leak diagnosis and from leak diagnosis to OTSC was 18 days (range 2–118), and 6 days (range 1–120), respectively. The initial endoscopic treatment was OTSC (n = 19), stent (n = 5), clip (n = 1), and clip and biologic glue (n = 1). OTSC alone led to final resolution of leak in 8 patients (31%) within 43 days of clip deployment (range 5–87). Five leaks resolved after a combination of OTSC and stent (19%) and one leak (4%) resolved after endoscopic suturing following a failed OTSC. Eleven patients (42%) failed endoscopic management and underwent total gastrectomy and esophagojejunostomy. One mortality (4%) was noted. The number of additional endoscopic sessions ranged from 1 to 10 (median 2). Conclusions OTSC carries a low success rate for controlling staple line leaks following LSG. Keywords Laparoscopic sleeve gastrectomy . Leaks . Over-the-scope clip . Bariatric surgery
Introduction According to the most recent publication by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric operation worldwide [1]. The primary major complication reported after LSG is leak, occurring in 0.5–2% of patients, and its management requires a complex, multidisciplinary approach [2]. It is commonly mentioned that leaks following LSG are more difficult * Ido Mizrahi [email protected] 1
Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
2
General Surgery, Hadassah-Hebrew University Medical Center Mount Scopus, P.O.B. 24035, 91240 Jerusalem, Israel
3
Department of Gastroenterology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
to treat than those following other bariatric procedures such as laparoscopic Roux-en-Y gastric bypass (LRYGB). This difficulty
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