Fluoroscopic-Guided Self-Expandable Retrievable Esophageal Stent Application in the Management of Postbariatric Surgery Anastomotic Leaks

Objectives: Anastomotic leakage is a major complication of bariatric surgeries that can lead to high mortality and morbidity. Depending on the clinical presentation, management options include conservative management with or without external drainage, stenting, or surgical re-intervention which carries relatively high morbidity and mortality rates. Methods: Self-expanding silicon stents were inserted under fluoroscopic guidance in 16 patients with radiologically diagnosed anastomotic leakage; nine of them postbariatric gastric bypass operation and seven patients after laparoscopic sleeve. Patients were referred for stenting between 7 and 26 days (mean 14 days) after surgery. Balloon repositioning was needed twice in one patient distal migration. The stent was left for 8 weeks in all patients. The patients were following a strictly fluid diet to avoid stent migration. Stents were removed endoscopically. All patients were followed till removal of the stents. Results: A 100% technical success was achieved defined as successful positioning of the stent bypassing the leakage. Distal migration occurred twice in the same patient with balloon repositioning. Persistence of the leakage after stent removal took place in seven patients (all were referred late 20 days plus postsurgery), six of which had re-surgery and one patient who had residual tubular cutaneous-anastomosis fistula had track coiling with cessation of leakage. Conclusion: Fluoroscopic-guided esophageal stenting might be effective in bypassing anastomotic leakages following bariatric surgeries; however, it should be considered as soon as significant leakage is diagnosed and should be considered before resurgery. Placement of the stents was feasible without major procedure-related complications.

Publication History

Article published online:
26 April 2021