AB016. OP16 Alternative method for the deployment of endoscopic stents in sleeve gastrectomy leaks
Abstract

AB016. OP16 Alternative method for the deployment of endoscopic stents in sleeve gastrectomy leaks

Çağhan Pekşen1, Osman Anil Savaş2, Talar Vartanyan3, Işil Yurdaişik4, Hüseyin Yetiş4, Aziz Sümer1

1Department of General Surgery, Faculty of Medicine, Istinye University, Istanbul, Turkey; 2Faculty of Medicine, Altinbaş University, School of Health Service, Istanbul, Turkey; 3Department of General Surgery, Bağcilar Education and Research Hospital, Istanbul, Turkey; 4Department of Radiology, Faculty of Medicine, Istinye University, Istanbul, Turkey

Correspondence to: Çağhan Pekşen. Department of General Surgery, Faculty of Medicine, Istinye University, Istanbul, Turkey. Email: caghanpeksen@gmail.com.

Background: Sleeve gastrectomy is the most common bariatric surgical procedure in the treatment of morbid obesity. The most common complications are leakage, bleeding and stenosis. The most feared complication is leakage. Leakage can be fatal if it diagnoses late. Measures can be taken to reduce the leakage rate by using the right technique, avoiding unnecessary manipulation of the his angle, preventing twist formation in the stomach, using a larger bougie, and using routine perop methylene blue test. The most important findings in the detection of leakage after sleeve gastrectomy are fever and tachycardia and the appearance of leakage on computed tomography. The most important factors in guiding the treatment are the patient’s clinical findings and the time elapsed from the occurrence of leakage. If the patient’s vital signs are not stable, surgical drainage antibiotherapy may be used. Endoscopic stent and antibiotherapy must be applied. In this case report for deployment of bigger stent, we used alternative technique with foley urinary catheter.

Methods and Results: The patient had fever, left shoulder pain and leukocytosis on the third day after sleeve gastrectomy. Abdominal tomography showed a proximal leak in the sleeve gastrectomy line. Diagnostic laparoscopy was performed because the patient was not suitable for percutaneous drainage. Leakage site was detected, cleaned, aspirated and sutured. Leakage recurred after the second surgery and endoscopic stent implanted. Biluribin levels increased on the second day after stent implantation. Migration of the stent to the duodenum was observed on the X-ray. Control gastroscopy revealed that the proximal end of the stent did not fit fully into the esophagus. Stent retracted. Foley urinary catheter was advanced alongside the gastroscope and inflated in the proximal site of the stent. We waited 2 minutes for the stent deployment. The proximal part of the stent placed in the esophagus. Leukocytosis regressed in the patient’s follow-up, her drain returned to normal and was withdrawn. Stent was removed at 8th week after discharge.

Conclusions: The foley urinary catheter can be passed by the side of the gastroscope and used for the non-deployed upper end of the endoscopic stent.

Keywords: Leakage; stent; urinary catheter


Footnote

Provenance and Peer Review: This abstract is included in “Abstracts from the 3rd Turkish National Congress on Bariatric and Metabolic Surgery, 21st-24th November 2019, Antalya-Turkey”, which is commissioned by the Guest Editor (Mehmet Mahir Özmen) for the series “Bariatric and Metabolic Surgery” published in Annals of Laparoscopic and Endoscopic Surgery. This abstract did not undergo external peer review.

Conflicts of Interest: The authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/ales-2019-bms-27). The series “Bariatric and Metabolic Surgery” was commissioned by the editorial office without any funding or sponsorship. The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

doi: 10.21037/ales-2019-bms-27
Cite this abstract as: Pekşen Ç, Savaş OA, Vartanyan T, Yurdaişik I, Yetiş H, Sümer A. OP16 Alternative method for the deployment of endoscopic stents in sleeve gastrectomy leaks. Ann Laparosc Endosc Surg 2020;5:AB016.