Abstract
Background and aims Postoperative leak is one of the most feared complications after bariatric surgery.
Endoscopic stenting is used to manage leaks by decreasing the gastrointestinal intraluminal
pressure. The main advantage of endoscopic management is providing healing while still
allowing for oral nutrition. However, limited literature exists on whether biodegradable
stents can be used to control leaks when conventional metallic stents fail.
Methods Our series consists of four patients who were found to have a leak as a complication
of bariatric surgery. Two patients were initially managed by abdominal/chest drainage,
and one required total parenteral nutrition. Conventional endoscopic exclusion techniques
with short and long fully covered metallic stents were tried and failed in three of
the four patients included in this series. Thus, biodegradable stents were used as
a rescue option.
Results Biodegradable stents provided immediate improvement for all of the patients, and
Gastrografin studies were leak-free 2 days after the procedure. All patients were
started on oral feeding and discharged home within 5 – 6 days later. Minimum outpatient
follow-up of 8 weeks was achieved with no issues. Follow-up endoscopy was performed
2 – 3 months later in three patients and showed completely resorbed stents. The only
drawback was the mucosal reaction to the stent causing dysphagia in two patients,
who eventually needed esophageal dilatation.
Conclusion Biodegradable stents have the potential to provide a reasonable rescue option to
manage post bariatric surgery leaks in patients who fail conventional endoscopic exclusion
methods. However, data from larger studies are needed to collect information on which
theoretical advantages/disadvantages of degradable biomaterials apply to real practice.
