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Inicio Cirugía Española (English Edition) The Role of Endoprostheses in the Treatment of Leaks after Laparoscopic Sleeve G...
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Vol. 98. Issue 7.
Pages 373-380 (August - September 2020)
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Vol. 98. Issue 7.
Pages 373-380 (August - September 2020)
Special Article
DOI: 10.1016/j.cireng.2020.07.015
The Role of Endoprostheses in the Treatment of Leaks after Laparoscopic Sleeve Gastrectomy. Analysis of a Spanish Registry
Papel de las endoprótesis en el tratamiento de las fistulas posgastrectomía vertical laparoscópica. Análisis de un registro nacional
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Carmen Balaguéa,
Corresponding author
cbalague@santpau.cat

Corresponding author.
, Sonia Fernandez-Ananína, Ainitze Ibarzabalb, Marta Parísc, Ramón Vilallongad, José Julian Puchee, Juan Carlos Ruiz de Adanaf
a Servicio de Cirugía General y Digestiva, Hospital de la Santa Creu i Sant Pau, UAB, Barcelona, Spain
b Servicio de Cirugía General y Digestiva, Hospital Clinic, UB, Barcelona, Spain
c Servicio de Cirugía General y Digestiva, Hospital Sant Joan de Reus, Reus, Spain
d Servicio de Cirugía General y Digestiva, Hospital de la Vall d’Hebron, UAB, Barcelona, Spain
e Servicio de Cirugía General y Digestiva, Hospital General Universitario, Valencia, Spain
f Servicio de Cirugía General y Digestiva, Hospital Universitario de Getafe, Getafe, Spain
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Figures (2)
Tables (5)
Table 1. Epidemiological Data.
Table 2. Main Form of Presentation in Patients Treated With Stents as the First Treatment Option.
Table 3. Univariate and Multivariate Studies for Complications.
Table 4. Univariate and Multivariate Studies for Treatment Effectiveness.
Table 5. Results of Stents According to Time of Use.
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Abstract

It has been suggested that endoprostheses are an effective treatment for fistulae after sleeve gastrectomy, but the results published are very variable. To analyze the effectiveness of stents as treatment of leakage after sleeve gastrectomy, the Spanish Society of Obesity Surgery (SECO) and the Obesity Division of the Spanish Association of Surgeons (AEC) set up a National Registry to record treatments of leaks after sleeve gastrectomy. We have analyzed patients with leaks after sleeve gastrectomy and treated with endoprostheses: 19 medical centers reported the use of endoprostheses, where 51 endoprostheses were used in 42 patients (34 women/8 men, mean age: 43.8 years, BMI: 47.6). Global effectiveness was 45%, with a complication rate of 35%. Uni- and multivariate analyses detected no factors influencing the efficacy of treatment. A larger diameter bouggie used to calibrate the stomach was related to a higher incidence of complications. No factors were found related with better stent efficacy. The effectiveness of a second stent was very low when the previous one had not been effective.

Keywords:
Sleeve gastrectomy
Fistula
Leaks
Endoprostheses
Stents
Endoscopic treatment
Bariatric surgery
Resumen

Se ha propuesto la endoprótesis como tratamiento eficaz de la fístula tras gastrectomía vertical, pero existe variabilidad en los resultados publicados. Para evaluar la efectividad de la endoprótesis como tratamiento de la fuga posgastrectomía vertical, La Sociedad Española de Cirugía de la Obesidad (SECO) y la Sección de Obesidad de la Asociación Española de Cirujanos (AEC) propusieron a sus miembros participar en un registro nacional donde incluir a pacientes con fístula posgastrectomía vertical. Analizamos los tratados con endoprótesis. Diecinueve centros han utilizado endoprótesis. Se colocaron 51 endoprótesis en 42 pacientes, 34 M/8 H, edad media: 43,8 años, IMC: 47,6. Efectividad global: 45%, con 35% de complicaciones. El estudio uni- y multivariado no objetivó factores determinantes de la eficacia del tratamiento. Un mayor diámetro del tubo gástrico se relacionó con una mayor incidencia de complicaciones. No hemos encontrado factores implicados en la efectividad de la endoprótesis. Apenas es efectiva una segunda endoprótesis si la primera no lo fue.

Palabras clave:
Gastrectomía vertical
Fístulas
Fugas
Endoprótesis
Stents
Tratamiento endoscópico
Cirugía bariátrica

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