Background and study aims: Diverse endoscopic methods, such as placement of temporary self-expandable stents,
have proven effective for the treatment of post-bariatric surgery leaks. However,
some patients do not respond to the usual endoscopic treatment. This study tested
the efficacy of an alternative treatment strategy based on trans-fistulary drainage
with double-pigtail plastic stents.
Patients and methods: We performed a retrospective analysis of patients with abdominal collections following
bariatric surgery who were treated by trans-fistulary stenting between May 2007 and
February 2015. Clinical success was defined as a sustained (> 4 months) clinical resolution
(patient discharged from the hospital without antibiotics and able to resume a normal
diet) and radiological response. Patient records, radiological images, and the hospital
endoscopy database were reviewed.
Results: A total of 33 patients (26 women/7 men, mean age 42 years [SD 11.2]) were included.
Collections occurred after sleeve gastrectomy (n = 28) or after gastric bypass (n = 5).
Fourteen patients were treated by trans-fistulary stenting as primary treatment, and
19 patients had undergone previous unsuccessful endoscopic treatment. No serious complication
occurred during the drainage procedure. Clinical success was achieved in 26 patients
(78.8 %). In two successfully treated patients, stents are still in place. Spontaneous
stent migration occurred in 12 patients. In 12 patients, the stents were removed,
either electively (n = 5) or because of complications (ulcerations n = 3, upper gastrointestinal
symptoms n = 3, splenic hematoma n = 1).
Conclusions: Trans-fistulary drainage of post-bariatric abdominal collections is safe and associated
with high success rates. This technique can be considered in previously untreated
patients, when a collection is not properly drained percutaneously, or after failure
of other endoscopic treatments.
