Combined endoscopic-laparoscopic T-tube insertion for the treatment of staple-line leak after sleeve gastrectomy: a simple and effective therapeutic option

Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery
Marco BarrecaDouglas E Whitelaw

Abstract

Management of staple-line leak after laparoscopic sleeve gastrectomy (LSG) remains controversial and matter of debate. Transforming a leak into a controlled fistula by insertion of a T-tube is a viable option. To minimize surgical dissection, and to facilitate identification of the leak site and insertion of the T-tube, we have developed a combined endoscopic-laparoscopic T-tube (ELT-t) insertion technique. Between February 2011 and June 2014, 7 patients presented with staple-line leak and were treated with ELT-t insertion. After laparoscopic dissection of the abscess cavity, a guidewire is passed endoscopically through the leak; a polypectomy snare is anchored to the guidewire and retrieved through the patient mouth. The long arm of a T-tube is eventually secured to the snare and pulled down through the leak. All patients were started on oral feeding with the T-tube in place. Serial water-soluble contrast swallows were performed to check for healing, and the T-tube was clamped as soon as no extravasation of contrast was demonstrated. The tube was removed either during the index admission or in the outpatient clinic. The residual fistula closed successfully after T-tube removal in all but one case with a "spiral-shaped" sleeve ...Continue Reading

References

Jun 7, 2008·Obesity Surgery·Ronit T YehoshuaMoshe Rubin
Nov 8, 2011·The Surgical Clinics of North America·Stacy A Brethauer
Dec 20, 2011·Surgical Endoscopy·Alexander R AuroraAlan A Saber
Jan 18, 2012·Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery·Raul J RosenthalNatan Zundel
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Jun 27, 2013·La Radiologia medica·Mario CoronaFabrizio Fanelli
Jan 7, 2014·World Journal of Gastrointestinal Surgery·Majid A AlmadiAbdulrahman M Aljebreen

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Citations

Apr 22, 2017·Journal of Laparoendoscopic & Advanced Surgical Techniques. Part a·Andrea BallaAlessandro M Paganini

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