Stent Management of Leaks After Bariatric Surgery: a Systematic Review and Meta-analysis.

Autor: Martínez Hernández A; Department of General Surgery, University General Hospital, Castellon, Spain. andreumh92@gmail.com., Beltrán Herrera H; Department of General Surgery, University General Hospital, Castellon, Spain., Martínez García V; Department of Mathematics, Jaume I University, Castellon, Spain., Ibáñez Belenguer M; Department of General Surgery, University General Hospital, Castellon, Spain., Queralt Martín R; Department of General Surgery, University General Hospital, Castellon, Spain., Maiocchi Segredo AK; Department of General Surgery, University General Hospital, Castellon, Spain., Aliaga Hilario E; Department of General Surgery, University General Hospital, Castellon, Spain., Laguna Sastre JM; Department of General Surgery, University General Hospital, Castellon, Spain.; Jaume I Univeristy, Castellon, Spain.
Jazyk: angličtina
Zdroj: Obesity surgery [Obes Surg] 2022 Apr; Vol. 32 (4), pp. 1034-1048. Date of Electronic Publication: 2022 Feb 07.
DOI: 10.1007/s11695-022-05890-8
Abstrakt: Background: Despite the low rates of complications of bariatric surgery, gastrointestinal leaks are major adverse events that increase post-operative morbidity and mortality. Endoscopic treatment using self-expanding stents has been used in the therapeutic management of these complications with preliminary good results.
Methods: We performed a systematic review and meta-analysis of self-expanding stents placement for the management of gastrointestinal leaks after obesity surgery. Overall proportion of successful leak closure, stent migration, and reoperation were analysed as primary outcomes. Secondary outcomes were patients' clinical characteristics, duration and type of stent, other stent complications, and mortality.
Results: A meta-analysis of studies reporting stents was performed, including 488 patients. The overall proportion of successful leak closure was 85.89% (95% CI, 82.52-89.25%), median interval between stent placement and its removal of 44 days. Stent migration was noted in 18.65% (95% CI, 14.32-22.98%) and the overall proportion of re-operation was in 13.54% (95% CI, 9.94-17.14%). The agreement between reviewers for the collected data gave a Cohen's κ value of 1.0. No deaths were caused directly by complications with the stent placement.
Conclusions: Endoscopic placement of self-expanding stents can be used, in selected patients, for the management of leaks after bariatric surgery with a high rate of effectiveness and low mortality rates. Nevertheless, reducing stent migration and re-operation rates represents an important challenge for future studies.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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