Use of Self-Expandable Metal Stents in the Treatment of Leaks Complicating Laparoscopic Sleeve Gastrectomy: A Cohort Study.

Abstract

Use of a self-expandable metal stent (SEMS) as an initial intervention for leaks after laparoscopic sleeve gastrectomy (LSG) has increased. We assessed the efficacy and safety of SEMS in the treatment of post-LSG leaks, and the determinants of repeated rounds of stenting. A retrospective chart review was conducted at a university hospital in Saudi Arabia. The study included patients who developed leaks after undergoing LSG between October 2011 and April 2016. Sixty-four patients (mean age, 35.69 ± 10.71years) were included; 55% were males. The mean estimated size of the defect was 1.18cm; partially covered SEMS and fully covered SEMS were used as the initial stents in 82.81 and 17.19% patients, respectively. One round of stenting was required in most patients (82.81%), two rounds in 10.94%, and three rounds in 6.25%. Clinical success was achieved in 93.75% patients, including 78.13% in the first round, 89.06% by the second round, and 93.75% by the third round. A higher proportion of patients who needed one round of stenting received a partially covered SEMS compared to those who needed two rounds (91.11 vs. 42.86%, p < 0.01). Additionally, the rate of migration in patients who underwent two rounds was higher than that in patients who underwent one round (42.86 vs. 5.26%, p < 0.01) of stenting. Repeated stenting for leaks after LSG is an effective and safe intervention. The efficacy of partially covered SEMS appears superior to that of the fully covered SEMS.