Murino Alberto, Arvanitakis Marianna, Le Moine Olivier, Blero Daniel, Devière Jacques, Eisendrath Pierre
Department of Gastroenterology, Hepato-Pancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, 808 route de Lennik, 1070, Brussels, Belgium,
Obes Surg. 2015 Sep;25(9):1569-76. doi: 10.1007/s11695-015-1596-8.
Endoscopic management of post-bariatric surgery leaks using self-expandable metal stents (SEMSs) is an alternative to revisional surgery. We evaluated the effectiveness of a standardized protocol for management of post-bariatric surgery leaks in a large cohort of patients.
Data from patients with anastomotic leaks after bariatric surgery endoscopically treated with partially covered SEMS in our institution between January 2006 and December 2012 were retrospectively reviewed. Patients were divided into four categories: (1) healing of fistula after only one SEMS, (2) healing of fistula after multiple SEMSs and/or additional therapy, (3) healing of fistula after salvage endoscopic procedure despite SEMS failure, and (4) SEMS and endoscopic failure for fistula healing.
Ninety-one patients (median age 42 years; 33 males) were considered suitable for inclusion. Our standardized stenting policy was successful in 74 patients (81 %). Among the 17 patients with SEMS failure, 6 patients were ultimately healed by internal drainage of the leakage (7 %). Endoscopic treatment failed in 11 patients (12 %). In univariate analysis, male gender (p = 0.024), higher prebariatric surgery BMI (p = 0.025), and shorter delay between surgery and SEMS placement (p = 0.011) were more frequently observed in the one-step treatment group (group 1) as compared to the other groups. In multivariate analysis, gender (p = 0.035) and delay between surgery and SEMS placement (p = 0.042) were independent predictive factors of endoscopic success.
Endoscopic management using SEMS for anastomotic leaks after bariatric surgery is effective and may avoid risky surgical reintervention in 81 % of patients. Early stenting was a major significant factor associated with increased success.
使用自膨式金属支架（SEMS）对减重手术后渗漏进行内镜治疗是翻修手术的一种替代方法。我们评估了在一大群患者中管理减重手术后渗漏的标准化方案的有效性。
回顾性分析2006年1月至2012年12月在我院接受内镜下部分覆盖SEMS治疗的减重手术后吻合口漏患者的数据。患者分为四类：（1）仅放置一个SEMS后瘘口愈合；（2）放置多个SEMS和/或接受额外治疗后瘘口愈合；（3）尽管SEMS治疗失败，但经挽救性内镜治疗后瘘口愈合；（4）SEMS和内镜治疗均未能使瘘口愈合。
91例患者（中位年龄42岁；男性33例）被认为适合纳入研究。我们的标准化支架置入策略在74例患者（81%）中取得成功。在17例SEMS治疗失败的患者中。有6例最终通过渗漏的内引流治愈（7%）。11例患者（12%）内镜治疗失败。在单因素分析中，与其他组相比，一步治疗组（第1组）男性（p = 0.024）、减重手术前较高的BMI（p = 0.025）以及手术与SEMS置入之间较短的延迟（p = 0.011）更为常见。在多因素分析中，性别（p = 0.035）和手术与SEMS置入之间的延迟（p = 0.042）是内镜治疗成功的独立预测因素。
使用SEMS对减重手术后吻合口漏进行内镜治疗是有效的，并且可以避免81%的患者进行有风险的手术再次干预。早期置入支架是与成功率增加相关的一个主要重要因素。
