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Surgical Endoscopy

, Volume 32, Issue 5, pp 2281–2287 | Cite as

Endoscopic transmural management of abdominal fluid collection following gastrointestinal, bariatric, and hepato-bilio-pancreatic surgery

  • Gianfranco Donatelli
  • David Fuks
  • Fabrizio Cereatti
  • Guillaume Pourcher
  • Thierry Perniceni
  • Jean-Loup Dumont
  • Thierry Tuszynski
  • Bertrand Marie Vergeau
  • Bruno Meduri
  • Brice Gayet
Article

Abstract

Background

Post-operative collections are a recognized source of morbidity after abdominal surgery. Percutaneous drainage is currently considered the standard treatment but not all collections are accessible using this method. Since the adoption of EUS, endoscopic transmural drainage has become an attractive option in the management of such complications. The present study aimed to assess the efficacy, safety and modalities of endoscopic transmural drainage in the treatment of post-operative collections.

Methods

Data of all patients referred to our dedicated multidisciplinary facility from 2014 to 2017 for endoscopic drainage of symptomatic post-operative collections after failure of percutaneous drainage or when it was deemed impossible, were retrospectively analyzed.

Results

Thirty-two patients (17 males and 15 females) with a median age of 53 years old (range 31–74) were included. Collections resulted from pancreatic (n = 10), colorectal (n = 6), bariatric (n  = 5), and other type of surgery (n  = 11). Collection size was less than 5 cm in diameter in 10 (31%), between 5 and 10 cm in 17 (53%) ,and more than 10 cm in 5 (16%) patients. The median time from surgery to endoscopic drainage was 38 days (range 6–360). Eight (25%) patients underwent endoscopic guided drainage whereas 24 (75%) patients underwent EUS-guided drainage. Technical success was 100% and clinical success was achieved in 30 (93.4%) after a mean follow-up of 13.5 months (1.2–24.8). Overall complication was 12.5% including four patients who bled following trans-gastric drainage treated with conservative therapy.

Conclusions

The present series suggests that endoscopic transmural drainage represents an interesting alternative in the treatment of post-operative collection when percutaneous drainage is not possible or fails.

Keywords

Fluid collection EUS drainage Surgical complication Double pigtail plastic stent Internal drainage Intra-abdominal collection Pseudocyst Wall off necrosis 

Notes

Compliance with ethical standards

Disclosures

Gianfranco Donatelli, David Fuks, Fabrizio Cereatti, Guillaume Pourcher, Thierry Perniceni, Jean-Loup Dumont, Thierry Tuszynski, Bertrand Marie Vergeau, Bruno Meduri, Brice Gayet have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Gianfranco Donatelli
    • 1
  • David Fuks
    • 2
  • Fabrizio Cereatti
    • 3
  • Guillaume Pourcher
    • 2
  • Thierry Perniceni
    • 2
  • Jean-Loup Dumont
    • 1
  • Thierry Tuszynski
    • 1
  • Bertrand Marie Vergeau
    • 1
  • Bruno Meduri
    • 1
  • Brice Gayet
    • 2
  1. 1.Unité d’Endoscopie Interventionnelle, Ramsay Générale de SantéHôpital Privé des PeupliersParisFrance
  2. 2.Department of Digestive SurgeryInstitut Mutualiste MontsourisParisFrance
  3. 3.Digestive Endoscopy and Gastroenterology UnitA.O. Istituti Ospitalieri di CremonaCremonaItaly

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