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Role of Percutaneous Glue Treatment After Persisting Leak After Laparoscopic Sleeve Gastrectomy
Ramon Vilallonga1, Jacques Himpens2, Barbara Bosch2
1Division of Bariatric Surgery, AZ St-Blasius, Kroonveldlaan 52, 9200, Dendermonde, Belgium. vilallongapuy@hotmail.com.
Background:
Over the years, many treatment modes have been attempted for gastrocutaneous fistula (GCF) after laparoscopic sleeve gastrectomy (LSG). Minimally invasive techniques for GCF treatment include stent placement and radiological percutaneous glue treatment (GT).
Material And Method:
Ten patients underwent a radiological acrylate mixed with contrast medium GT combined or not with other treatment strategies such as relaparoscopy, ultrasound, or computerized tomography scan (CT scan)-guided drain and endoscopic stent placement.
Results:
Ten patients (mean age 47.1 years, range 64-29) were treated by percutaneous injection of glue after LSG leak. Body mass index (BMI) was 42.2 kg/m(2) ± 6.7 at the time of LSG surgery. Mean time between LSG and leak diagnosis was 12 days (range 4-31 days). GT was only effective when performed after endoscopic stent placement (80 % resolution). With this regimen, five patients required a laparoscopic Roux limb placement. All fistulas eventually healed a mean of 75 days (range 29-293 days) after GCF diagnosis.
Conclusions:
Percutaneous glue treatment alone does not seem to provide adequate results. Stenting previous to the glue treatment allows for better results.
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