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Endoscopic Double-Pigtail Catheter (EDPC) Internal Drainage as First-Line Treatment of Gastric Leak: A Case Series during Laparoscopic Sleeve Gastrectomy Learning Curve for Morbid Obesity

Authors :
Gianni Lazzarin
Alessandra Di Sibio
Beatrice Pessia
Francesco Carlei
Michele Marchese
Antonio Giuliani
Marino Di Furia
Carla Di Giacomo
Loreto Lombardi
Mario Schietroma
Lucia Romano
Source :
Minimally Invasive Surgery, Vol 2020 (2020), Minimally Invasive Surgery
Publication Year :
2020
Publisher :
Hindawi Limited, 2020.

Abstract

Objectives. The prevalence of morbid obesity has dramatically increased over the last several decades worldwide, currently reaching epidemic proportions. Gastric leak (GL) remains the potentially fatal main complication after sleeve gastrectomy (SG) for morbid obesity. To our knowledge, there are no standardized guidelines for GL treatment after laparoscopic sleeve gastrectomy (LSG) yet. The aim of this study was to represent our institutional preliminary experience using the endoscopic double-pigtail catheter (EDPC) as the method of internal drainage and propose it as first-line treatment in case of GL after LSG. Methods. One hundred and seventeen patients were admitted to our surgical department and underwent laparoscopic sleeve gastrectomy (LSG) for morbid obesity from March 2014 to June 2019. In 5 patients (4.3%) of our series, GL occurred as a complication of LSG. EPDC was the stand-alone procedure of internal drainage and GL first-line treatment. The internal pig tail was endoscopically removed from 30th to 40th POD in all cases. Results. Present data (clinical, biochemical, and instrumental tests) showed a complete resolution of GL, with promotion of a pseudodiverticula and complete re-epithelialization of leak. Follow-up was more strict than usual (clinical visit and biochemical test on 7th, 14th, and 21st day after discharge; a CT scan with gastrografin on 30th day from discharge if clinical visit and exams were normal). Conclusion. This was a preliminary retrospective observational study, conducted on 5 patients affected by GL as a complication of LSG for morbid obesity. EDPC maintains the safety, efficacy, and nonexpensive characteristic and may be proposed as better first-line treatment in case of GL after bariatric surgery.

Details

ISSN :
20901453 and 20901445
Volume :
2020
Database :
OpenAIRE
Journal :
Minimally Invasive Surgery
Accession number :
edsair.doi.dedup.....46a8786df4eeceb6b3e86fe639294796
Full Text :
https://doi.org/10.1155/2020/8250904