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Case Report

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

Min Sun Ryu, Ki-Nam Shim, Won Young Cho, Chan Young Kim1, Hyeon-Ju Kang, Mi Yeon Kim, So Young Ahn, Yoon Pyo Lee, Hyoung Won Cho, Sung Ae Jung, Joo-Ho Lee1
The Ewha Medical Journal 2013;36(2):135-138. Published online: September 26, 2013

Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

1Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea.

Corresponding author: Ki-Nam Shim. Department of Internal Medicine, Ewha Womans University School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 158-710, Korea. Tel: 82-2-2650-2632, Fax: 82-2-2655-2076, shimkn@ewha.ac.kr
• Received: February 19, 2013   • Accepted: July 21, 2013

Copyright © 2013. Ewha Womans University School of Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • 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.
  • Keywords: Fibrin tissue adhesive; Fistula; Gastrectomy; Obesity; Stent
  • 1. Korea Centers for disease Control and Prevention2011 Korea National Health and Nutrition Examination Survey [Internet] Cheongwon, Korea Centers for disease Control and Prevention. 2012;cited 2013 Aug 7. Available from: http://knhanes.cdc.go.kr/knhanes/index.do
  • 2. Lee JM. Body weight change of Korean. Press release of Ministry of Health and Welfare [Internet] Seoul, Ministry of Health and Welfare. 2012;cited 2013 Aug 7. Available from: http://www.mw.go.kr/front_new/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&page=39&CONT_SEQ=277826
  • 3. Oshiro T, Kasama K, Umezawa A, Kanehira E, Kurokawa Y. Successful management of refractory staple line leakage at the esophagogastric junction after a sleeve gastrectomy using the HANAROSTENT. Obes Surg 2010;20:530-534.
  • 4. Fuks D, Verhaeghe P, Brehant O, Sabbagh C, Dumont F, Riboulot M, et al. Results of laparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity. Surgery 2009;145:106-113.
  • 5. Burgos A, Braghetto I, Csendes A, Maluenda F, Korn O, Yarmuch J, et al. Gastric leak after laparoscopic-sleeve gastrectomy for obesity. Obes Surg 2009;19:1672-1677.
  • 6. Casella G, Soricelli E, Rizello M, Trentino P, Fiocca F, Fantini F, et al. Nonsurgical treatment of staple line leaks after laparoscopic sleeve gastrectomy. Obes Surg 2009;19:821-826.
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.
emj-36-135-g001.jpg
Fig. 2
Endoscopic findings. (A) Postoperative leak is noted at upper sleeve site (arrow). (B) Esophageal covered stent was placed on postoperative day 24.
emj-36-135-g002.jpg
Fig. 3
Gastrografin study findings after stent insertion. (A) Stent is placed at upper sleeve without migration. (B) There is no leak.
emj-36-135-g003.jpg
Fig. 4
Endoscopic finding after stent removal. The leak is completely closed (arrow).
emj-36-135-g004.jpg

Figure & Data

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.
emj-36-135-g001.jpg
Fig. 2
Endoscopic findings. (A) Postoperative leak is noted at upper sleeve site (arrow). (B) Esophageal covered stent was placed on postoperative day 24.
emj-36-135-g002.jpg
Fig. 3
Gastrografin study findings after stent insertion. (A) Stent is placed at upper sleeve without migration. (B) There is no leak.
emj-36-135-g003.jpg
Fig. 4
Endoscopic finding after stent removal. The leak is completely closed (arrow).
emj-36-135-g004.jpg

References

  • 1. Korea Centers for disease Control and Prevention2011 Korea National Health and Nutrition Examination Survey [Internet] Cheongwon, Korea Centers for disease Control and Prevention. 2012;cited 2013 Aug 7. Available from: http://knhanes.cdc.go.kr/knhanes/index.do
  • 2. Lee JM. Body weight change of Korean. Press release of Ministry of Health and Welfare [Internet] Seoul, Ministry of Health and Welfare. 2012;cited 2013 Aug 7. Available from: http://www.mw.go.kr/front_new/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&page=39&CONT_SEQ=277826
  • 3. Oshiro T, Kasama K, Umezawa A, Kanehira E, Kurokawa Y. Successful management of refractory staple line leakage at the esophagogastric junction after a sleeve gastrectomy using the HANAROSTENT. Obes Surg 2010;20:530-534.
  • 4. Fuks D, Verhaeghe P, Brehant O, Sabbagh C, Dumont F, Riboulot M, et al. Results of laparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity. Surgery 2009;145:106-113.
  • 5. Burgos A, Braghetto I, Csendes A, Maluenda F, Korn O, Yarmuch J, et al. Gastric leak after laparoscopic-sleeve gastrectomy for obesity. Obes Surg 2009;19:1672-1677.
  • 6. Casella G, Soricelli E, Rizello M, Trentino P, Fiocca F, Fantini F, et al. Nonsurgical treatment of staple line leaks after laparoscopic sleeve gastrectomy. Obes Surg 2009;19:821-826.

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    A Case of Endoscopic Closure to Postoperative Leak after Laparoscopic Sleeve Gastrectomy in Patient with Morbid Obesity
    Ewha Med J. 2013;36(2):135-138.   Published online September 26, 2013
    DOI: https://doi.org/10.12771/emj.2013.36.2.135
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    A Case of Endoscopic Closure to Postoperative Leak after Laparoscopic Sleeve Gastrectomy in Patient with Morbid Obesity
    Ewha Med J. 2013;36(2):135-138.   Published online September 26, 2013
    DOI: https://doi.org/10.12771/emj.2013.36.2.135
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    A Case of Endoscopic Closure to Postoperative Leak after Laparoscopic Sleeve Gastrectomy in Patient with Morbid Obesity
    Image Image Image Image
    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.
    Fig. 2 Endoscopic findings. (A) Postoperative leak is noted at upper sleeve site (arrow). (B) Esophageal covered stent was placed on postoperative day 24.
    Fig. 3 Gastrografin study findings after stent insertion. (A) Stent is placed at upper sleeve without migration. (B) There is no leak.
    Fig. 4 Endoscopic finding after stent removal. The leak is completely closed (arrow).

    Fig. 1

    Fig. 2

    Fig. 3

    Fig. 4

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