Treatment of a staple-line leak after laparoscopic sleeve gastrectomy using an esophagoduodenal Niti-S Mega-stent.

Abstract

Listen

Translate article

A 56-year-old female with class 3 obesity, was previously submitted to laparoscopic sleeve gastrectomy (LSG) two weeks before current admission. The patient was admitted due to fever, abdominal pain and vomiting. CT revealed a 13.5cm collection between the gastric wall and left hepatic lobe. Piperacillin-Tazobactam was initiated, and percutaneous drainage of the purulent collection was performed. The upper endoscopy showed pus in the gastric lumen and a 10-mm leak at the esophago-gastric junction with contrast extravasation. Argon plasma coagulation (40W, 2L/min) was applied at the orifice margins to promote healing. After 0,038'' guidewire placement through the proximal jejunum, a Niti-S™-MEGA™ (Mega-Stent) 28x230mm (Taewoong Medical™) was deployed under fluoroscopic control. CT at 72h showed absence of leakage. Oral nutrition was started uneventfully. Ambulatory endoscopy was scheduled for eight weeks later to remove the stent, which was easily accomplished with a foreign body forceps. Granulation tissue was observed in the previous leak location and no extraluminal contrast was observed at fluoroscopic evaluation, confirming complete healing and successful endoscopic treatment. Three weeks after stent removal, the patient presented with dysphagia. Upper endoscopy revealed a short and narrowed lumen stenosis at 28cm from the incisives, which was easily manage through TTS balloon dilation. No additional complications were observed.