Endoscopic Management of Leaks after LSG

All consecutive patients who underwent LSG in Saint Michel Private Hospital (Toulon, France) between January 2017 and December 2020 were included in the current study. All files of the patients diagnosed with leak in the postoperative period were carefully reviewed and their outcome analyzed retrospectively. After collecting the demographic data (age, gender BMI), the symptomatology was analyzed along with the radiological studies. Patient’s hemodynamic status directed the treatment approach in performing the drainage of the collection through laparoscopy or with endoscopy alone. The parenteral nutrition, triple antibiotics, and fluid management were systematically associated. No feeding jejunostomy was used. In case of surgical drainage, a systematic endoscopy was performed in the first two weeks after surgery. In case of a patient with no hemodynamic instability, the endoscopic approach was preferred, and the endoscopic drainage was realized using pigtail drains when the orifice was smaller than 10 mm or with a nasocavitary drain in the case of larger orifices. When the patient was unstable and needing the control of a severe infection, the first step was the laparoscopic lavage with drainage of the peritoneal cavity, which were realized in an emergency setting. The algorithm of the endoscopic treatment (Figure 1) was completed with endoscopic septotomy associated with balloon dilation or pigtail insertion, depending on the leak size, time of diagnosis, and associated stenosis. We have also analyzed the number of endoscopic sessions, the duration of treatment, and the healing rate for the endoscopic treatment. During this approach, parenteral nutrition was administered for 2 weeks with repetitive studies being performed between 4 and 6 weeks. The entire healing process was protected through the administration of a double dose of Proton Pump Inhibitors (PPIs).
All procedures carried out in studies on human participants complied with the ethical standards of the national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All individual participants included in the study signed an informed consent. The ethical board of our institution gave its approval for the study.