Advanced endolumenal management of acute and chronic leaks after bariatric surgery

Abstract

Leaks remain an infrequent yet dreaded complication following bariatric surgery. Effective management includes appropriate classification of leaks and implementation of a multimodality treatment approach that focuses on adequate resuscitation, control of sepsis, and surgical or endoscopic intervention when necessary. Herein, we describe several endoscopic techniques that have demonstrated success in the management of acute and chronic leaks following bariatric surgery. In general, endoscopic interventions can be classified as exclusion techniques (self-expanding endoscopic stents), closure techniques (endoscopic clips, endoscopic suturing, or glues), or drainage techniques (transfistulary stents, endolumenal vacuum therapy, or septotomy). To guide the clinician in the appropriate patient selection for these interventions, we provide a suggested algorithm for the management of patients presenting with acute or chronic leaks following bariatric surgery.