974 SUCCESSFUL ENDOSCOPIC MANAGEMENT OF GASTRIC SLEEVE LEAK COMPLICATED BY ABSCESS AND TRANSFASCIAL DRAINAGE

Abstract

A 66 year-old female underwent a sleeve gastrectomy complicated by postoperative bleed requiring laparotomy. She developed a postoperative sleeve dehiscence with intraabdominal abscess and transfascial drainage. Surgical options were morbid and included gastric resection or gastrointestinal diversion. As the patient was stable, endoscopic therapy was attempted. Initial upper endoscopy revealed a proximal staple line dehiscence, and a large abdominal abscess that could be traversed with the scope out of the midline wound. Endoscopic debridement was followed by negative pressure would therapy (NPWT) in an endoluminal fashion (eVAC). Transoral eVAC placement across the dehiscence into the abscess was placed in communication with NPWT from external wound. Serial treatments were completed until the abscess cavity and staple line closed. Subsequent upper GI study did not demonstrate ongoing leak and diet was resumed. Endoscopic management of gastric sleeve leaks is a safe and reliable technique to manage enteric defects. Though endoluminal vacuum therapy requires inpatient hospitalization, it can successfully close gastric sleeve leaks, especially in combination with abdominal NPWT in the setting of transfascial abscess drainage. This endoscopic therapy avoids morbid surgical operations.