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Gastrointest Endosc. 2011 Feb;73(2):238-44. doi: 10.1016/j.gie.2010.10.010.

An endoscopic strategy for management of anastomotic complications from bariatric surgery: a prospective study.

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  • 1Department of Gastroenterology and Hepatology, North Hospital, Marseille, France.

Abstract

BACKGROUND:

Treatment of anastomotic fistulas after bariatric surgery is difficult, and they are often associated with additional surgery, sepsis, and prolonged non-oral feeding.

OBJECTIVE:

To assess a new, totally endoscopic strategy to manage anastomotic fistulas.

DESIGN:

Prospective study.

SETTING:

Tertiary-care university hospital.

PATIENTS:

This study involved 27 consecutive patients from July 2007 to December 2009.

INTERVENTION:

This strategy involved successive procedures for endoscopic drainage of the residual cavity, diversion of the fistula with a stent, and then closure of the residual orifice with surgical clips or sealant.

MAIN OUTCOME MEASUREMENTS:

Technical success, mortality and morbidity, migration of the stent.

RESULTS:

Multiple or complex fistulas were present in 16 cases (59%). Endoscopic drainage (nasal-fistula drain or necrosectomy) was used in 19 cases (70%). Diversion by a covered colorectal stent was used in 22 patients (81%). To close the residual or initial opening, wound clips and glue (cyanoacrylate) were used in 15 cases (55%). Neither mortality nor severe morbidity occurred. Migration of the stent occurred in 13 cases (59%) and was treated by replacement with either a longer stent or with 2 nested stents. The mean time until resolution of fistula was 86 days from the start of endoscopic management, with a mean of 4.4 endoscopies per patient.

LIMITATIONS:

Moderate sample size, nonrandomized study.

CONCLUSION:

An entirely endoscopic approach to the management of anastomosing fistulas that develop after bariatric surgery--using sequential drainage, sutures, and diversion by stents--achieved resolution of the fistulas with minimal morbidity.

Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

PMID:
21295637
[PubMed - indexed for MEDLINE]
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