Self-expandable metal stents to treat gastric leaks

Anastomotic leak is a major complication after gastric bypass (GBP) surgery, and it usually necessitates reoperation and is associated with long-term recovery and death. We present our experience with the use of self-expandable metal stents (SEMS) to treat this complication.

Seventeen patients (14 males and 3 females, mean body mass index of 43.7 kg/m(2)) with gastro-jejunal leak after GBP underwent covered SEMS placement 1 to 3 weeks after surgery: 8 laparoscopic, 5 open, and 4 revisional procedures. All patients who underwent laparoscopic and revisional procedures had abdominal drains placed at surgery. No drains were placed in the open cases. Five patients required surgery to drain an abdominal abscess.

Tolerance for oral feeding was achieved between 2 and 3 days after SEMS placement. One patient persisted with a minimal leak for 2 weeks. To date, all stents have been removed endoscopically 3.2 +/- 1.2 months after placement. Four patients needed a second session to complete removal of the uncovered top of the stent. Two esophageal mucosal tears occurred; both were managed conservatively. Sixteen patients had a totally sealed leak. One remained with a gastro-gastric fistula. One stent spontaneously migrated to the splenic flexure and was removed colonoscopically.

SEMS placement for gastro-jejunal leaks is a safe therapeutic option.