Insights into the treatment of postsleeve gastrectomy leak: analysis of the results of 105 cases on a national register.

BACKGROUND: Many options have been put forward to treat staple line leaks after sleeve gastrectomy (SG) but no clear consensus has emerged concerning a management algorithm. OBJECTIVES: Aiming to establish a pattern to tailor treatment, the Spanish Society of Obesity Surgery (SECO) and the Obesity Section of the Spanish Association of Surgeons (AEC) set up a national register to record treatment of leaks after SG. SETTING: Multiple hospital centers, Spain. METHODS: Between September 2016 and December 2017, cases were entered into an online database. Results were assessed according to the number and type of therapeutic procedures. RESULTS: One hundred and five patients from 27 centers were diagnosed with postSG leak. The mean age was 44 years, and 77 (73%) were women. Mean body mass index (BMI) was 47 kg/m2. Mortality was 7%. The first treatment was effective in 50% of cases with no significant differences between nonoperative management and surgery. We found no significant correlations between appearance of leak, type of treatment (nonoperative management or surgery), and treatment effectiveness. An endoscopic stent was the first nonoperative option in 30% of cases and second option in 50% of cases, with effectiveness of 61% and 50%, respectively. In patients requiring a third treatment option (n = 25), surgery was more effective than nonoperative treatment (75% versus 8%) and the incidence of complications secondary to endoscopic stent placement was high (71%). CONCLUSION: The choice of postSG leak treatment depends on the patient's clinical condition and the site of the leak. Healing may be slow (>2 months) and may require several interventions using different approaches such as nonoperative treatment, endoscopic stents, or surgery. The effectiveness of endoscopic options decreases and the effectiveness of complex resective or derivative surgery increases with leak duration and the number of treatments required.

Papel de las endoprótesis en el tratamiento de las fistulas posgastrectomía vertical laparoscópica. Análisis de un registro nacional / The role of endoprostheses in the treatment of leaks after laparoscopic sleeve gastrectomy. Analysis of a Spanish registry

Se ha propuesto la endoprótesis como tratamiento eficaz de la fístula tras gastrectomía vertical, pero existe variabilidad en los resultados publicados. Para evaluar la efectividad de la endoprótesis como tratamiento de la fuga posgastrectomía vertical, La Sociedad Española de Cirugía de la Obesidad (SECO) y la Sección de Obesidad de la Asociación Española de Cirujanos (AEC) propusieron a sus miembros participar en un registro nacional donde incluir a pacientes con fístula posgastrectomía vertical. Analizamos los tratados con endoprótesis. Diecinueve centros han utilizado endoprótesis. Se colocaron 51 endoprótesis en 42 pacientes, 34 M/8 H, edad media: 43,8 años, IMC: 47,6. Efectividad global: 45%, con 35% de complicaciones. El estudio uni- y multivariado no objetivó factores determinantes de la eficacia del tratamiento. Un mayor diámetro del tubo gástrico se relacionó con una mayor incidencia de complicaciones. No hemos encontrado factores implicados en la efectividad de la endoprótesis. Apenas es efectiva una segunda endoprótesis si la primera no lo fue

It has been suggested that endoprostheses are an effective treatment for fistulae after sleeve gastrectomy, but the results published are very variable. To analyze the effectiveness of stents as treatment of leakage after sleeve gastrectomy, the Spanish Society of Obesity Surgery (SECO) and the Obesity Division of the Spanish Association of Surgeons (AEC) set up a National Registry to record treatments of leaks after sleeve gastrectomy. We have analyzed patients with leaks after sleeve gastrectomy and treated with endoprostheses: 19 medical centers reported the use of endoprostheses, where 51 endoprostheses were used in 42 patients (34 women/8 men, mean age: 43.8 years, BMI: 47.6). Global effectiveness was 45%, with a complication rate of 35%. Uni- and multivariate analyses detected no factors influencing the efficacy of treatment. A larger diameter bouggie used to calibrate the stomach was related to a higher incidence of complications. No factors were found related with better stent efficacy. The effectiveness of a second stent was very low when the previous one had not been effective

The role of endoprostheses in the treatment of leaks after laparoscopic sleeve gastrectomy. Analysis of a Spanish registry. / Papel de las endoprótesis en el tratamiento de las fistulas posgastrectomía vertical laparoscópica. Análisis de un registro nacional.

It has been suggested that endoprostheses are an effective treatment for fistulae after sleeve gastrectomy, but the results published are very variable. To analyze the effectiveness of stents as treatment of leakage after sleeve gastrectomy, the Spanish Society of Obesity Surgery (SECO) and the Obesity Division of the Spanish Association of Surgeons (AEC) set up a National Registry to record treatments of leaks after sleeve gastrectomy. We have analyzed patients with leaks after sleeve gastrectomy and treated with endoprostheses: 19 medical centers reported the use of endoprostheses, where 51 endoprostheses were used in 42 patients (34 women/8 men, mean age: 43.8 years, BMI: 47.6). Global effectiveness was 45%, with a complication rate of 35%. Uni- and multivariate analyses detected no factors influencing the efficacy of treatment. A larger diameter bouggie used to calibrate the stomach was related to a higher incidence of complications. No factors were found related with better stent efficacy. The effectiveness of a second stent was very low when the previous one had not been effective.