Endoluminal endoscopic technologies in the treatment of complications after bariatric interventions

Purpose of the study. Demonstration of the experience of successful treatment of patients with the failure of the stapler suture line using various endoscopic technologies. Material and methods. In the period from December 2023 to January 2024, a 46-year-old patient with a body mass index of 51.3 and a 40-year-old patient with a body mass index of 49.3 were treated at the Vishnevsky National Research Medical Center for Surgery, who underwent laparoscopic sleeve gastric resection for morbid obesity. Results. In the first clinical observation, on the 4th day after surgery, the inconsistency of the stapler suture line was revealed. Taking into account the remaining area of failure of the stapler seam line after drainage under ultrasound control, the defect was closed using an OVESCO endoscopic clip. In the second clinical observation, due to the formation of a large cavity with a diameter of 9 cm, a vacuum aspiration system was installed. Subsequently, after removal of the vacuum aspiration system, due to the persistent defect in the wall of the stomach stump, the defect was also closed using an OVESCO endoscopic clip. Conclusion. Our study demonstrates the possibilities of intraluminal endoscopic technologies in the treatment of bariatric patients with staple suture line failure. Thus, the endoscopic approach in the treatment of patients with failure of the stapler suture line after bariatric interventions is a modern minimally invasive technique and an alternative to surgical interventions, provided adequate sanitation and drainage of abdominal congestion.

bariatric surgery, morbid obesity, endoscopic techniques, laparoscopic sleeve resection of the stomach, complications of bariatric patients

1. Antoine A.R., Basile M., El Masri H. Gastric leaks post sleeve gastrectomy: review of its prevention and management. World J Gastroenterol. 2014;20(38):13904-13910. doi: 10.3748/wjg.v20.i38.13904.

2. Hernández J., Boza C. Novel treatments for complications after bariatric surgery. Ann Surg Innov Res. 2016;10: 3. doi: 10.1186/s13022-015-0021-2.

3. Baker R.S., Foote J., Kemmeter P., Brady R., Vroegop T., Serveld M. The science of stapling and leaks. Obes Surg. 2004;14(10):1290-1298. doi: 10.1381/0960892042583888.

4. Parikh M., Issa R., McCrillis A., Saunders J.K., Ude-Welcome A., Gagner M. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg. 2013;257(2):231-237. doi: 10.1097/SLA.0b013e31826cc714.

5. Nedelcu M., Skalli M., Delhom E., Fabre J.M., Nocca D. New CT scan classification of leak after sleeve gastrectomy. Obes Surg. 2013 Aug;23(8):1341-3. doi: 10.1007/s11695-013-1002-3.

6. Welsch T., von Frankenberg M., Schmidt J., Büchler M.W. Diagnostik und Definition der Nahtinsuffizienz aus chirurgischer Sicht [Diagnosis and definition of anastomotic leakage from the surgeon’s perspective]. Chirurg. 2011 Jan;82(1):48-55. German. doi: 10.1007/s00104-010-1916-4.

7. Glaysher M., Khan O.A., Mabvuure N.T., Wan A., Reddy M., Vasilikostas G. Staple line reinforcement during laparoscopic sleeve gastrectomy: does it affect clinical outcomes? Int J Surg. 2013;11(4):286-9. doi: 10.1016/j.ijsu.2013.02.015.

8. Wahby M., Salama A.F., Elezaby A.F., Belgrami F., Abd Ellatif M.E., El-Kaffas H.F., Al-Katary M. Is routine postoperative gastrografin study needed after laparoscopic sleeve gastrectomy? Experience of 712 cases. Obes Surg. 2013 Nov;23(11):1711-7. doi: 10.1007/s11695-013-1013-0.

9. Rosenthal R.J.; International Sleeve Gastrectomy Expert Panel; Diaz A.A., Arvidsson D., Baker R.S., Basso N. et al.International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012 Jan-Feb;8(1):8-19. doi: 10.1016/j.soard.2011.10.019.

10. Kolyadko P.V., Kolyadko V.P., Degovtsov E.N., Samoilov V.S., Stepanenko A.V. Non-surgical treatment of staple-line suture leakage after redo sleeve gastrectomy. Pirogov Russian Journal of Surgery = Khirurgiya. Zurnal im. N.I. Pirogova. 2023;3:83-89. (In Russ.) doi: 10.17116/hirurgia202303183.@@ Колядко П.В., Колядко В.П., Деговцов Е.Н., Самойлов В.С., Степаненко А.В. Эндоскопическое клипирование несостоятельности линии степлерного шва после повторной продольной резекции желудка. Хирургия. Журнал им. Н.И. Пирогова. 2023;3:83-89. doi: 10.17116/hirurgia202303183.

11. Mennigen R., Colombo-Benkmann M., Senninger N., Laukoetter M. Endoscopic closure of postoperative gastrointestinal leakages and fistulas with the Over-the-Scope Clip (OTSC). J Gastrointest Surg. 2013 Jun;17(6):1058-65. doi: 10.1007/s11605-013-2156-y.

12. Woźniewska P., Diemieszczyk I., Hady H.R.Complications associated with laparoscopic sleeve gastrectomy - a review. Prz Gastroenterol. 2021;16(1):5-9. doi: 10.5114/pg.2021.104733.

13. ASGE Bariatric Endoscopy Task Force and ASGE Technology Committee; Abu Dayyeh B.K., Kumar N., Edmundowicz S.A., Jonnalagadda S., Larsen M., Sullivan S., Thompson C.C., Banerjee S. ASGE Bariatric Endoscopy Task Force systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting endoscopic bariatric therapies. Gastrointest Endosc. 2015 Sep;82(3):425-38.e5. doi: 10.1016/j.gie.2015.03.1964.

14. ASGE/ASMBS Task Force on Endoscopic Bariatric Therapy; Ginsberg G.G., Chand B., Cote G.A., Dallal R.M., Edmundowicz S.A., Nguyen N.T., Pryor A, Thompson CC. A pathway to endoscopic bariatric therapies. Gastrointest Endosc. 2011 Nov;74(5):943-53. doi: 10.1016/j.gie.2011.08.053.

15. Puli S.R., Spofford I.S., Thompson C.C. Use of self-expandable stents in the treatment of bariatric surgery leaks: a systematic review and meta-analysis. Gastrointest Endosc. 2012 Feb;75(2):287-93. doi: 10.1016/j.gie.2011.09.010.

16. Surace M., Mercky P., Demarquay J.F. et al. Endoscopic management of GI fistulae with the over-the-scope clip system (with video). Gastrointest Endosc. 2011 Dec;74(6):1416-9. doi: 10.1016/j.gie.2011.08.011.