Outcomes of a novel bariatric stent in the management of sleeve gastrectomy leaks: a multicenter study
| Autor: | Luiz Henrique de Sousa, Marcelo Falcão, Delano B. Almeida, Filipe Medeiros, Diogo Turiani Hourneaux de Moura, A. M. Amorim, João de Siqueira Neto, Ivan R B Orso, Igor Antunes Marchetti, J. Lima, Luiz Gustavo de Quadros, Flávio Heuta Ivano, Pichamol Jirapinyo, Manoel Galvao Neto, Eduardo Guimarães Hourneaux de Moura, Newton Teixeira, Christopher C. Thompson, Alvaro Albano, Durval Rosa Neto |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Sleeve gastrectomy Leak medicine.medical_treatment Fistula Bariatric Surgery Anastomotic Leak 030209 endocrinology & metabolism 03 medical and health sciences 0302 clinical medicine Gastrectomy medicine Humans Adverse effect Retrospective Studies medicine.diagnostic_test business.industry Stent Retrospective cohort study Middle Aged medicine.disease Obesity Morbid Surgery Endoscopy Treatment Outcome Multicenter study Female 030211 gastroenterology & hepatology business |
| Zdroj: | Surgery for Obesity and Related Diseases. 15:1241-1251 |
| ISSN: | 1550-7289 |
| DOI: | 10.1016/j.soard.2019.05.022 |
| Popis: | Background The management of laparoscopic sleeve gastrectomy leaks remains a challenge. This can be treated with placement of self-expandable metal stents, which are most effective in the acute and early settings. However, migration is a frequent adverse event (AE). Novel, fully covered stents with a larger proximal flare to limit migration designed specifically to treat postsleeve leaks were recently introduced. Objectives The aim of this study was to evaluate the safety and efficacy of a novel stent specifically designed for postsleeve leaks treatment. Setting Multicenter retrospective study. Methods This is a multicenter study, including patients with acute and early post laparoscopic sleeve gastrectomy leaks, treated with a large bariatric stent. The outcomes include technical success, clinical success, and safety profile. A multivariable regression was performed to assess predictors of success. Results Thirty-seven patients were included (10 acute and 27 early leaks), with 30 stents in the postpyloric (POST) and 7 in the prepyloric position. Technical success was 100%. Mean stent dwell time was 29.08 days. Clinical success was achieved in 78.37%. Leak duration, leak size, and stent dwell time did not correlate with clinical success. During follow-up, 8 patients had stent migration (21.62%) and all were in a POST position. AE poststent removal were also evaluated (prepyloric: 57.14% vs POST: 33.3%, P = .45). There was no difference between prepyloric and POST position in the severe AE analysis. Conclusions This novel, large-caliber, fully covered stent specifically designed for sleeve leaks appears to be effective at treating acute and early leaks. However, the large flanges and long stent length do not appear to reduce migration rate and may be associated with higher overall severe AE rates. Avoiding placement in the POST position may help mitigate migration risk; however, owing to the risk profile this stent should be used with caution. |
| Databáze: | OpenAIRE |
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