A novel dedicated endoscopic stent for staple-line leaks after laparoscopic sleeve gastrectomy: a case series

Surg Obes Relat Dis. 2014 Jul-Aug;10(4):607-11. doi: 10.1016/j.soard.2014.02.027. Epub 2014 Mar 1.

Abstract

Background: Staple-line leak is the most serious complication of laparoscopic sleeve gastrectomy (LSG) occurring in .5-7% of cases. Patients with this complication are often managed with an esophageal covered, self-expandable metal stent positioned at endoscopy. Unfortunately, migration of these stents has been reported in 30-50% of cases. A novel fully-covered, self-expanding metal stent (Megastent), specifically designed for post-LSG leaks is now available. The objective of this study was to describe the first case series of patients with a staple-line leak after LSG who were endoscopically managed with such a novel stent.

Methods: Four patients who developed a staple-line leak after LSG were treated by positioning a Megastent at endoscopy. The stents were removed after 8 weeks.

Results: A complete leak repair was achieved in all patients. No stent migration occurred. Prokinetic therapy was needed to treat vomiting episodes during stent presence. At endoscopic evaluation after stent removal, a decubitus lesion at the distal part of the duodenal bulb was observed.

Conclusion: These preliminary results would suggest the use of the Megastent as an option for stenting of a staple-line leak after LSG. Further studies are still necessary.

Keywords: Endoscopic therapy; Obesity; Postsurgical leak; Sleeve gastrectomy.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anastomotic Leak / diagnosis
  • Anastomotic Leak / etiology
  • Anastomotic Leak / therapy*
  • Equipment Design
  • Female
  • Gastrectomy / adverse effects*
  • Humans
  • Laparoscopy / adverse effects*
  • Male
  • Middle Aged
  • Obesity, Morbid / surgery*
  • Stents*
  • Surgical Stapling / adverse effects*