Ewha Med J.  2013 Sep;36(2):135-138. 10.12771/emj.2013.36.2.135.

A Case of Endoscopic Closure to Postoperative Leak after Laparoscopic Sleeve Gastrectomy in Patient with Morbid Obesity

• Ryu MS
• Shim KN
• Cho WY
• Kim CY
• Kang HJ
• Kim MY
• Ahn SY
• Lee YP
• Cho HW
• Jung SA
• Lee JH

• KMID: 2171248
• DOI: http://doi.org/10.12771/emj.2013.36.2.135

Abstract

Laparoscopic sleeve gastrectomy can reduce morbidity and mortality in patients with morbid obesity, but it can cause complications such as a gastrointestinal leak. A 30-year-old morbidly obese female who had type 2 diabetes mellitus and hypertension with estimated body mass index of 40.2 kg/m2 was admitted. Laparoscopic sleeve gastrectomy was performed. On postoperative day 19, a leak was suspicious on physical examination and radiologic findings. Conservative management was performed, but the patient was hemodynamically unstable and imminently septic. After laparoscopic drainage procedure, esophagogastroduodenoscopy was performed and revealed the fistula opening at staple line just below gastroesophageal junction. Fibrin tissue adhesive was injected around the fistula and the esophageal covered stent was inserted to cover the leak. At 14th days after stent insertion, the barium study confirmed no more leak. In this case, we experienced that the esophageal stent insertion with fibrin tissue adhesive injection may reduce recovery time of the fistula developed after laparoscopic sleeve gastrectomy.

Keyword

Fibrin tissue adhesive; Fistula; Gastrectomy; Obesity; Stent

MeSH Terms

Adult
Body Mass Index
Diabetes Mellitus, Type 2
Drainage
Endoscopy, Digestive System
Esophagogastric Junction
Female
Fibrin Tissue Adhesive
Fistula
Gastrectomy*
Humans
Hypertension
Obesity
Obesity, Morbid*
Physical Examination
Stents
Barium
Fibrin Tissue Adhesive

Figure

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  Fig. 1 Abdominal computed tomography findings. (A) Leak at anastomosis site are seen on postoperative day 19 (arrow). (B) Leak is not improved in spite of percutaneous drainage.

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  Fig. 2 Endoscopic findings. (A) Postoperative leak is noted at upper sleeve site (arrow). (B) Esophageal covered stent was placed on postoperative day 24.

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  Fig. 3 Gastrografin study findings after stent insertion. (A) Stent is placed at upper sleeve without migration. (B) There is no leak.

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  Fig. 4 Endoscopic finding after stent removal. The leak is completely closed (arrow).

Reference

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