141bbcbe33afc76f37b577fb99c8a07f pmc_9963979.pdf c1de9224aced77719b9f7c6201c750c6af683f51 pmc_9963979.pdf 810c37a3a031b454f052e772035af29f779ad05174c24f5cc14698abaf2cf0c3 pmc_9963979.pdf Title: Is the Surgical Drainage Mandatory for Leak after Sleeve Gastrectomy? Subject: 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. Keywords: sleeve gastrectomy; endoscopy; surgical drainage; double pigtail; septotomy Author: Marius Nedelcu, Thierry Manos, Patrick Noel, Marc Danan, Viola Zulian, Ramon Vilallonga, Anamaria Nedelcu and Sergio Carandina Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Thu Feb 9 08:41:31 2023 CET ModDate: Thu Feb 9 08:46:16 2023 CET Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 7 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 845531 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- IHDRXS+VnURWPalladioL Type 1 Custom yes yes no 10 0 DXJLZA+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 NFDGKB+URWPalladioL-Roma Type 1 Custom yes yes no 20 0 TOTWGP+URWPalladioL-Ital Type 1 Custom yes yes no 24 0 XPUSBJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 42 0 BSDWLC+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 45 0 TFNRKZ+CMSY10 Type 1 Builtin yes yes no 67 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 79 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 83 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 87 0 BCDHEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 91 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 103 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 107 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 111 0 BCDHEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 115 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2023-07-11 02:34:19 CEST RepresentationInformation: pmc_9963979.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2023-03-02 02:17:01 CET Size: 845531 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 198 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@44c8afef Item: Title: Materials and Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7b69c6ba Item: Title: Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@46daef40 Item: Title: Discussion Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@12f41634 Item: Title: Conclusions Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@13c27452 Item: Title: References Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@262b2c86 Info: Title: Is the Surgical Drainage Mandatory for Leak after Sleeve Gastrectomy? Author: Marius Nedelcu, Thierry Manos, Patrick Noel, Marc Danan, Viola Zulian, Ramon Vilallonga, Anamaria Nedelcu and Sergio Carandina Subject: 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. 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