Successful Treatment of Gastric Sleeve Leaks With Insertion of Removable Self Expanding Metal Stents: A Case Series

Abstract

Background: Laparoscopic sleeve gastrectomy, a standard procedure for the surgical treatment of patients with obesity is associated with post operative gastric sleeve leak and cause significant morbidity and mortality. Case presentation: We describe four cases of patients with leak after gastric sleeve surgery for morbid obesity. Post operatively the patients were noted to have gastric sleeve leak. All four patients underwent placement of the self expandable metal stent in the leaking gastric sleeve. The stents were left in place for four to eight weeks for the leaks to heal and then removed. All four patients showed healing of the leak after the stent was removed and no further leaks were observed. In one patient the stent was noted to migrate and functionally obstruct at the distal end due to narrowing and mucosal swelling at the gastric sleeve. The stent was fully recovered and replaced with another stent. The leak later healed well and the stent was subsequently removed after six weeks. Discussion: Gastric sleeve surgery is usually done for morbid obesity. Although the surgery helps in reducing morbidity, it also has its known complications including gastric sleeve leak, staple line bleeding, strictures and enterocutaneous fistulas. Out of all the complications gastric sleeve leak causes highest morbidity. Removable stent placement is fairly new treatment option for gastric sleeve leaks and is gaining popularity. The stent placement helps in recovery in most patients. Gastric leaks at proximal and mid aspect can be treated with endoscopic stent placement. The complications related to stent placement include stent blockage, migration or kinking. Conclusion: Gastric sleeve leaks can be treated successfully with removable self expandable metal stents placed endoscopically and is associated with fewer complications.