Clin Endosc.  2021 Nov;54(6):805-809. 10.5946/ce.2020.298.

Endoscopic Management of Staple Line Leak after Bariatric Surgery: Surgeon’s Perspective

• Chung Y
• Park DG
• Kim YJ

• KMID: 2522699
• DOI: http://doi.org/10.5946/ce.2020.298

Abstract

Laparoscopic sleeve gastrectomy (LSG) has become a standalone primary procedure as a bariatric metabolic surgery since the early 2000s. The overall complication rate of LSG is reported to range from 2% to 15%. Staple line leakage (SLL) remains a major adverse event and occurs in approximately 1%–6% of patients. Choosing the optimal treatment modality is a complex process. Clinicians must understand that nutritional support and drainage of fluid collection are essential for initial management. Conservative endoscopic management and sufficient drainage can resolve approximately 70% of SLLs. Endoscopic management of bariatric complications has been rapidly evolving in recent years and can be considered in all patients who are hemodynamically stable. We will review the available endoscopic management techniques, including stent placement (self-expanding stents and bariatric-specific stents), clipping, tissue sealant application, and internal drainage (double-pigtail stents [DPS] placement, endoscopic vacuum therapy, and septotomy). Stent placement remains the mainstream treatment for SLLs. However, healing with stents requires multiple sessions/stents and a long course of recovery. Endoscopic internal drainage is gaining popularity and has the potential to be a superior method. The importance of early intervention and combined endoscopic methods should be recognized.

Keyword

Drainage; Morbid; Obesity; Stents; Surgical Stapling

Figure

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  Fig. 1. Management algorithm for staple line leakage. CT, computed tomography; EVT, endoscopic vacuum therapy; SSL, staple line leakage; UGI, upper gastrointestinal. *The procedures are recommended in the order of the item numbers. The method of internal drainage should be selected according to the experience and preference of the endoscopist. †Roux-en-Y fistulojejunostomy is the preferred surgical method.

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