ENDOSCOPIC TREATMENT OF STAPLE LINE LEAKAGE AFTER SLEEVE GASTRECTOMY USING THE VACUUMASSISTED CLOSURE SYSTEM

Abstract

Obesity has become a worldwide pandemic that has led to an increase in morbidity and mortality in patients, both young and old. Bariatric surgery is the most efficient therapy for morbid obesity. Sleeve gastrectomy has become the most popular bariatric procedure worldwide. The advantages of LSG include excellent weight loss, resolution of comorbidities, relatively simple technique, avoidance of foreign body, relatively short operation time and immediate restriction of caloric intake. However, staple line leakage is the most feared postoperative complications after sleeve gastrectomy. Traditional treatment option like surgery is associated with high morbidity and mortality. Therapeutic endoscopy plays a major role in the management of postbariatric complications, offering an effective treatment alternative to repeated surgery. Endoscopic vacuum therapy has shown to be a new successful and feasible treatment option for leaks after major gastro-esophageal surgery. The aim of our study was to evaluate the results of treatment of staple line leakage after sleeve gastrectomy using endoscopic vacuum therapy and to review the literature on this topic. Endoscopic vacuum therapy was initiated on postoperative day 14. We report a case of the endoscopic vacuum therapy principle being applied in a patient with the staple line leak after sleeve gastrectomy. In total, 4 endoscopic interventions were performed, the vacuum sponge being replaced endoscopically every 5 days. Hospital length of stay was 43 days. No relevant procedure related complications were observed during the course of therapy. Endoscopic vacuum therapy has the potential to succeed as a nonsurgical, feasible, safe, and effective treatment option for postoperative leaks in patients after sleeve gastrectomy. Further research is needed to better define its indications, to compare it to traditional treatments and to evaluate its long-term efficacy. Improvement in device design and customization could further improve success and ease of placement.

Keywords

• obesity,sleeve gastrectomy,staple line leakage,endoscopic vacuum therapy