Endoscopic internal drainage for the management of leak, fistula, and collection after sleeve gastrectomy: our experience in 617 consecutive patients

被引：34

作者：

Donatelli, Gianfranco ^{[1
]}

Spota, Andrea ^{[1
,2
]}

Cereatti, Fabrizio ^{[1
,3
]}

Granieri, Stefano ^{[4
]}

Dagher, Ibrahim ^{[5
]}

Chiche, Renaud ^{[6
]}

Catheline, Jean-Marc ^{[7
]}

Pourcher, Guillaume ^{[8
]}

Rebibo, Lionel ^{[9
]}

Calabrese, Daniela ^{[9
]}

Msika, Simon ^{[9
]}

Dammaro, Carmelisa ^{[5
]}

Tranchart, Hadrien ^{[5
]}

Lainas, Panagiotis ^{[5
]}

Tuszynski, Thierry ^{[1
]}

Pacini, Filippo ^{[10
]}

Arienzo, Roberto ^{[10
]}

Chevallier, Jean-Marc ^{[10
]}

Trelles, Nelson ^{[11
]}

Lazzati, Andrea ^{[12
]}

Paolino, Luca ^{[12
]}

Papini, Federica ^{[13
]}

Torcivia, Adriana ^{[14
]}

Genser, Laurent ^{[14
]}

Arapis, Kostas ^{[9
]}

Soprani, Antoine ^{[6
]}

Randone, Bruto ^{[15
]}

Chosidow, Denis ^{[15
]}

Bouillot, Jean-Luc ^{[16
]}

Marmuse, Jean-Pierre ^{[17
]}

Dumont, Jean-Loup ^{[1
]}

机构：

[1] Hop Prive Peupliers, Ramsay Gen Sante, Unite Endoscopie Intervent, 8 Pl Abbe G Henocque, F-75013 Paris, France

[2] Univ Milan, Scuola Specializzaz Chirurg Gen, Milan, Italy

[3] ASST Cremona, Gastroenterol Endoscopia Digest, Viale Concordia 1, Cremona, Italy

[4] ASST Vimercate, Gen Surg Unit, Vimercate, Italy

[5] Antoine Beclere Hosp, AP HP, Dept Minimally Invas Digest Surg, Clamart, France

[6] Clin Geoffry St Hilaire, Serv Chirurg Digest & Obes, Paris, France

[7] Ctr Hosp St Denis, Dept Digest Surg, St Denis, France

[8] Paris Descartes Univ, Inst Mutualiste Montsouris, Dept Digest Dis, Obes Ctr, Paris, France

[9] Hop Bichat Claude Bernard, Serv Chirurg Digest Oesogastr & Bariatr, Paris, France

[10] Hop Priv Peupliers, Ramsay Sante, Ctr Obes Paris Peupliers, Paris, France

[11] Ctr Hosp Rene Dubos, Serv Chirurg Gen & Digest, Pontoise, France

[12] Ctr Hosp Intercommunal Creteil, Dept Digest Surg, Creteil, France

[13] Grp Hosp Nord Essonne Site Orsay, Serv Chirurg Digest, Orsay, France

[14] Sorbonne Univ, Pitie Salpetriere Univ Hosp, APHP, Dept Hepatobiliary & Pancreat Surg, Paris, France

[15] Clin Parc Monceau, Serv Chirurg Digest & Obes, Paris, France

[16] Hop Paris St Joseph, Serv Chirurg Digest & Obes, Paris, France

[17] Clin Bizet, Serv Chirurg Digest & Obes, Paris, France

来源：

SURGERY FOR OBESITY AND RELATED DISEASES | 2021年 / 17卷 / 08期

关键词：

Double pigtails; Leak; Fistula; Sleeve gastrectomy; LAMS; EUS; Collection; Endoscopic internal drainage; BARIATRIC SURGERY; MORBID-OBESITY; WEIGHT-LOSS; GUIDELINES; STENTS; RISK; LINE; SIZE;

D O I：

10.1016/j.soard.2021.03.013

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Background: Endoscopy plays a pivotal role in the management of adverse events (AE) following bariatric surgery. Leaks, fistulae, and post-operative collection after sleeve gastrectomy (SG) may occur in up to 10% of cases. Objectives: To evaluate the efficacy and safety of endoscopic internal drainage (EID) for the management of leak, fistula, and collection following SG. Setting: Retrospective, observational, single center study on patients referred from several bariatric surgery departments to an endoscopic referral center. Methods: EID was used as first-line treatment for the management of leaks, fistulae, and collections. Leaks and fistulae were treated with double pigtail stent (DPS) deployment in order to guarantee internal drainage and second intention cavity obliteration. Collections were treated with endoscropic ultrasound (EUS)-guided deployment of DPS or lumen apposing metal stents. Results: A total of 617 patients (83.3% female; mean age, 43.1 yr) were enrolled in the study for leak (n = 300, 48.6%), fistula (n = 285, 46.2%), and collection (n = 32, 5.2%). Median follow-up was 19.5 months. Overall clinical success was 84.7% whereas 15.3% of cases required revisional surgery after EID failure. Clinical success according to type of AE was 89.5%, 78.5%, and 90% for leak, fistula, and collection, respectively. A total of 10 of 547 (1.8%) presented a recurrence during follow-up. A total of 28 (4.5%) AE related to the endoscopic treatment occurred. At univariate logistic regression predictors of failure were: fistula (OR 2.012), combined endoscopic approach (OR 2.319), need for emergency surgery (OR 1.755), and previous endoscopic treatment (OR 4.818). Conclusion: Early EID for the management of leak, fistula, and post-operative collection after SG seems a safe and effective first-line approach with good long-term results. (C) 2021 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

引用

页码：1432 / 1439

页数：8

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