Quezada Nicolás, Maiz Cristóbal, Daroch David, Funke Ricardo, Sharp Allan, Boza Camilo, Pimentel Fernando
Department of Digestive Surgery. School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, patio interior, División de Cirugía, Región Metropolitana, Santiago, Chile,
Obes Surg. 2015 Oct;25(10):1816-21. doi: 10.1007/s11695-015-1622-x.
Postoperative leaks are a dreaded complication after bariatric surgery (BS). Its treatment is based on nutritional support and sepsis control by antibiotics, collections drainage and/or prosthesis, and/or surgery.
The aim of this study is to report our experience with coated self-expandable endoscopic stents (SEES) for leaks treatment.
This study was performed in a University Hospital, (censored).
We performed a retrospective analysis of our BS database from January 2007 to December 2013. All patients with leak after BS treated with SEES were included.
We identified 29 patients; 17 (59%) were women, with median age of 37 (19-65) years, and preoperative body mass index of 40 (28.7-56-6) kg/m(2). Nineteen (65.5%) patients had a sleeve gastrectomy and 10 (34.5%) a Roux-en-Y gastric bypass. All patients had a leak in the stapler line. Median time from surgery to leak diagnosis was 7 (1-51) days, and SEES were installed 8 (0-104) days after diagnosis. Twenty-one (72%) patients also had abdominal exploration. Median length of SEES use was 60 (1-299) days. Patients who had SEES as primary treatment (with or without simultaneous reoperation) had a shorter leak closure time (50 [6-112] vs 109 [60-352] days; p = 0.008). Twenty-eight (96.5%) patients successfully achieved leak closure with SEES. There were 16 migrations in 10 (34%) patients, 1 (3%) stent fracture, 1 opening of the blind end of alimentary limb (3%), and 5 patients (17%) required a second stent due to leak persistence.
SEES is a feasible, safe, and effective management of post BS leaks, although patients may also require prosthesis revision and abdominal exploration. Primary SEES placement is associated with a shorter leak resolution time.
术后渗漏是减重手术（BS）后令人恐惧的并发症。其治疗基于营养支持以及通过抗生素控制感染、引流积液和/或置入假体和/或进行手术。
本研究旨在报告我们使用带涂层的自膨式内镜支架（SEES）治疗渗漏的经验。
本研究在一家大学医院（已删节）进行。
我们对2007年1月至2013年12月期间的BS数据库进行了回顾性分析。纳入所有接受SEES治疗的BS术后渗漏患者。
我们确定了29例患者；17例（59%）为女性，中位年龄37岁（19 - 65岁），术前体重指数为40（28.7 - 56.6）kg/m²。19例（65.5%）患者接受了袖状胃切除术，10例（34.5%）接受了Roux - Y胃旁路术。所有患者均在吻合器缝合线处发生渗漏。从手术到渗漏诊断的中位时间为7天（1 - 51天），诊断后8天（0 - 104天）置入SEES。21例（72%）患者还进行了腹部探查。SEES使用的中位时长为60天（1 - 299天）。以SEES作为主要治疗手段（无论是否同时再次手术）的患者渗漏闭合时间较短（50天[6 - 112天]对109天[60 - 352天]；p = 0.008）。28例（96.5%）患者通过SEES成功实现渗漏闭合。10例（34%）患者发生16次支架移位，1例（3%）支架断裂，1例（3%）消化道肢体盲端开口，5例（17%）患者因渗漏持续需要置入第二个支架。
SEES是一种可行、安全且有效的减重手术后渗漏管理方法，尽管患者可能还需要假体修复和腹部探查。初次置入SEES与较短的渗漏解决时间相关。
