Is the Surgical Drainage Mandatory for Leak after Sleeve Gastrectomy?
Nedelcu, Marius (ELSAN, Clinique Bouchard)
Manos, Thierry (ELSAN, Clinique Saint Michel)
Noel, Patrick (Mediclinic Airport Road Hospital, Abu Dhabi)
Danan, Marc (ELSAN, Clinique Saint Michel)
Zulian, Viola (ELSAN, Clinique Saint Michel)
Vilallonga, Ramon (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Nedelcu, Anamaria (ELSAN, Clinique Bouchard)
Carandina, Sergio (ELSAN, Clinique Saint Michel)

Fecha:	2023
Resumen:	Introduction: Despite the unanimous acknowledgement of the laparoscopic sleeve gastrectomy (LSG) worldwide, the leak remains its deficiency. For the last decade, the surgical treatment was practically considered mandatory for almost any collection following LSG. The aim of this study is to evaluate the need for surgical drainage for leak following LSG. Methods: All consecutive patients having gone through LSG from January 2017 to December 2020 were enrolled in our study. Once the demographic data and the leak history were registered, we analyzed the outcome of the surgical or endoscopic drainage, the characteristics of the endoscopic treatment, and the evolution to complete healing. Results: A total of 1249 patients underwent LSG and the leak occurred in 11 cases (0. 9%). There were 10 women with a mean age of 47. 8 years (27-63). The surgical drainage was performed for three patients and the rest of the eight patients underwent primary endoscopic treatment. The endoscopic treatment was represented with pigtails for seven cases and septotomy with balloon dilation for four cases. In two out of these four cases, the septotomy was anticipated by the use of a nasocavitary drain for 2 weeks. The average number of endoscopic procedures was 3. 2 (range 2-6). The leaks achieved complete healing after an average duration of 4. 8 months (range 1-9 months). No mortality was recorded for a leak. Conclusions: The treatment of the gastric leak must be tailored to each patient. Although there is still no consensus for the endoscopic drainage of leaks after LSG, the surgical approach can be avoided in up to 72%. The benefits of pigtails and nasocavitary drains followed by endoscopic septotomy are undeniable, and they should be included in the armamentarium of any bariatric center.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Sleeve gastrectomy ; Endoscopy ; Surgical drainage ; Double pigtail ; Septotomy
Publicado en:	Journal of clinical medicine, Vol. 12 (february 2023) , ISSN 2077-0383

DOI: 10.3390/jcm12041376
PMID: 36835912

7 p, 825.7 KB

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