Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France.
ELSAN, Clinique Bouchard, Marseille, France.
Surg Obes Relat Dis. 2021 Feb;17(2):340-344. doi: 10.1016/j.soard.2020.09.028. Epub 2020 Sep 23.
Due to the large number of laparoscopic sleeve gastrectomy (LSG) performed over the last decade, the management of the leak following LSG has been increasingly reported. The role of covered Self Expandable Metal Stents (cSEMS) for the treatment of the leak is still controversial because of the poor tolerance and high risk of complications.
The aim of the present study was to analyze the foregut wall perforation and aorta injuries, a very rare but potentially fatal complication, related to the treatment of the leak following LSG using cSEMS.
Private hospital, France.
An audit was conducted in 2 French tertiary bariatric endoscopic centers focusing on aortic injuries after cSEMS use for leak. We examined and classified the initial procedure, leak characteristics, primary endoscopic treatment, and outcome of endoscopic complication for each eligible case.
A total of 5 patients were identified with foregut wall perforation and aorta injuries. All stents were deployed for staple line leak following LSG. The recorded mortality in case of esophageal-aortic injuries related to cSEMS use was 80%.
cSEMS are potentially effective tools for the management of foregut leaks in bariatric surgery. The biggest challenges with this approach are stent migration and poor quality of life. Caution is required due to the risk of fatal complications such as foregut wall perforation and aortic injury.
由于过去十年中腹腔镜袖状胃切除术（LSG）数量的增加，LSG 后漏的处理越来越受到关注。覆盖自膨式金属支架（cSEMS）在治疗漏方面的作用仍存在争议，因为其耐受性差且并发症风险高。
本研究旨在分析使用 cSEMS 治疗 LSG 后漏时出现的非常罕见但潜在致命的胃壁穿孔和主动脉损伤并发症。
法国私立医院。
在法国的 2 个三级减重内镜中心进行了一项审核，重点关注 cSEMS 使用后发生的主动脉损伤。我们检查并对每个符合条件的病例的初始手术、漏的特征、初次内镜治疗和内镜并发症的结果进行了分类。
共发现 5 例胃壁穿孔和主动脉损伤患者。所有支架均因 LSG 后吻合口漏而放置。与 cSEMS 使用相关的食管-主动脉损伤的死亡率为 80%。
cSEMS 是治疗减重手术中胃漏的有效工具。这种方法最大的挑战是支架迁移和生活质量差。由于存在胃壁穿孔和主动脉损伤等致命并发症的风险，因此需要谨慎。
