Kim Zisun, Kim Yong Jin, Kim Yong Jae, Goo Dong Erk, Cho Joo Young
Department of Surgery, Soonchunhyang University College of Medicine, Seoul, Korea.
Surg Laparosc Endosc Percutan Tech. 2011 Aug;21(4):e206-8. doi: 10.1097/SLE.0b013e3182258bf5.
Laparoscopic sleeve gastrectomy (LSG) is a feasible option for morbid obesity. But gastric leak is one of the most dreadful complications. We report our experience of staple line leak, which was managed successfully with vascular plug and covered stent.
A staple line leak occurred after LSG. Followed attempts of reoperation, drainage procedures of abscess cavity, and repeated endoscopic treatments were all unavailing. Finally, vascular plug was placed at fistula tract and consequent endoscopic covered stent placement could propose the solution.
Granulation tissue, which occluded the fistula tract was identified by computed tomographic scan 2 weeks after stent placement. Leak healed successfully, and the patient discharged safely a week after stent removal.
We consider inducing granulation tissue by applying vascular plug at fistula tract in combination with covered stent placement, which is a safe and effective therapeutic option for management of intractable staple line leak after LSG.
腹腔镜袖状胃切除术（LSG）是治疗病态肥胖的一种可行选择。但胃漏是最可怕的并发症之一。我们报告了我们处理吻合口漏的经验，通过血管封堵器和覆膜支架成功处理了该问题。
LSG术后发生了吻合口漏。随后的再次手术尝试、脓肿腔引流程序以及反复的内镜治疗均无效。最后，在瘘道处放置了血管封堵器，随后进行内镜覆膜支架置入提供了解决方案。
支架置入2周后，计算机断层扫描显示肉芽组织堵塞了瘘道。漏口成功愈合，患者在支架取出1周后安全出院。
我们认为通过在瘘道处应用血管封堵器并结合覆膜支架置入来诱导肉芽组织形成，这是处理LSG术后难治性吻合口漏的一种安全有效的治疗选择。
