Endoscopic Tools and Techniques for Fistula and Leaks
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.
KeywordsBariatric Surgery Anastomotic Leak Fibrin Glue Anastomotic Complication Endoscopic Stenting
Endoscopic bronchoesophageal fistula closure (MOV 255395 kb)
OTSC clip for flexible endoscopy (MOV 305025 kb)
OS for approximation of anastomatic leaks and fixation of stent (MOV 190658 kb)
- 3.Anon. ASMBS guideline on the prevention and detection of gastrointestinal leak after gastric bypass including the role of imaging and surgical exploration. Surg Obes Relat Dis. 2009;5(3):293–6.Google Scholar
- 4.Anon. Updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis. 2010;6(1):1–5.Google Scholar
- 8.Spyropoulos C, Argentou M-I, Petsas T, et al. Management of gastrointestinal leaks after surgery for clinically severe obesity. Surg Obes Relat Dis Off J Am Soc Bariatric Surg. 2011. http://www.ncbi.nlm.nih.gov/pubmed/21616725. Accessed 23 Oct 2011.
- 34.Vanbiervliet G, Filippi J, Karimdjee BS, et al. The role of clips in preventing migration of fully covered metallic esophageal stents: a pilot comparative study. Surg Endosc. 2011. http://www.ncbi.nlm.nih.gov/pubmed/21792721. Accessed 12 Dec 2011.