Exploring Endoscopic Solutions for Staple Line Dehiscence Following Sleeve Gastrectomy

A forty-one-year-old woman presented to the emergency department with abdominal pain and fever one week after undergoing sleeve gastrectomy. Blood work revealed elevated inflammatory markers. An abdominal CT scan showed a gastric anastomosis dehiscence complicated by hydropneumoperitoneum. Intravenous antibiotics were initiated. After a multidisciplinary discussion, a totally covered endoscopic metal stent was placed, and the collection was surgically drained via percutaneous drainage. Endoscopic evaluation for stent removal, three weeks later, indicated persistent dehiscence with an estimated collection of 70 mm and purulent drainage. Two double pigtail stents were placed to allow internal drainage. Due to persistent fever and elevated inflammatory markers, an alternative endoscopic treatment was performed involving the placement of a modified intraluminal vacuum therapy using a nasojejunal probe, which facilitated both collection drainage and enteric feeding. In conjunction with this strategy, multiple sessions of septotomy and functional stenosis dilation with a pneumatic balloon were performed. Three months after the initial hospital admission and seven therapeutic upper endoscopies, the patient was discharged without the need for surgical reintervention. While there are no established algorithms for managing complications from bariatric surgery, growing evidence suggests that endoscopy can be effective in diagnosing and treating them. The authors present a complex case of bariatric dehiscence that required a multidisciplinary approach and a variety of endoscopic therapies, highlighting their potential in this context.

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Artikel online veröffentlicht:
27. März 2025