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Endoscopic Tools and Techniques for Fistula and Leaks

  • Ahmed Sharata
  • Lee L. SwanstromEmail author
Chapter

Abstract

Since the first attempts at intestinal anastomoses, leaks and fistulas have been a constant problem. In particular, the rising prevalence of morbid obesity and corresponding increase in the volume of bariatric surgery have led to a mounting experience with associated gastrointestinal anastomotic complications. Anastomotic or staple-line leaks after gastrointestinal surgery are relatively uncommon complications, but quite morbid and potentially lethal.

Although it is a relatively uncommon surgery, esophagectomy has a substantial risk of anastomotic leak or fistulization due to its lack of serosa and relative ischemia of its reconstruction options. There is between a 3 and 21 % rate of esophageal anastomotic leaks and they can become fistulas to mediastinal structures including vascular (usually fatal) or pulmonary (highly morbid). There are also a small, but real, incidence of spontaneous (Boerhaave’s) and iatrogenic upper gastrointestinal tract perforations.

Keywords

Bariatric Surgery Anastomotic Leak Fibrin Glue Anastomotic Complication Endoscopic Stenting 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video 12.1

Endoscopic bronchoesophageal fistula closure (MOV 255395 kb)

Video 12.2

OTSC clip for flexible endoscopy (MOV 305025 kb)

Video 12.3

OS for approximation of anastomatic leaks and fixation of stent (MOV 190658 kb)

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of General and Minimally Invasive SurgeryOregon ClinicPortlandUSA
  2. 2.Division of Gastrointestinal and Minimally Invasive SurgeryThe Oregon Clinic, Oregon Health and Sciences UniversityPortlandUSA

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