Endoscopic Management of Leaks After Bariatric Surgery and Factors Affecting Treatment Success: Single Center Results

Aims Bariatric surgery is increasingly being performed, and among its complications, leaks are the most serious and life-threatening. Our aim is to investigate the outcomes of endoscopic interventions on patients with post-bariatric surgery leakage and to explore the factors influencing success, failure, and complications.

Methods This was a cross-sectional study involving patients referred to our clinic for endoscopic treatment of leaks after bariatric surgery between April 2014 and October 2023. The analysis evaluated bariatric procedure type, leak site, treatment timing, endoscopic findings, intervention details, presence of distal sleeve stricture, complications, and mortality.

Results Sixty-one patients (36 females, 59.02%) with a median age of 38 (33 – 49) years were included. Fifty-five patients (90.16%) were successfully treated with endoscopic treatment methods. Among 55 patients, 12 patients (19.67%) were treated with bariatric stent only, 10 patients (16.39%) were treated with internal drainage only, and 7 patients (11.48%) were treated with an over-the-scope clip only. In other patients (42.62%), different endoscopic treatment methods and percutaneous drainage were used in combination. Endoscopy-related complications occurred in 12 (19.67%) patients, with the most common being stent migration (6.56%). Endoscopic intervention had failed and required re-surgery in six (9.84%) patients. One (1.64%) patient died due to sepsis following re-surgery. Unsuccessful cases had significantly larger self-limited cavity sizes (p=0.009). The endoscopic intervention count was significantly higher among those with endoscopy-related complications (p=0.030). The number of endoscopic interventions was correlated with self-limited cavity presence (r=0.482, p<0.001) and use of internal drainage (r=0.477, p<0.001).

Conclusions Endoscopic management of leaks that develop after bariatric surgery can achieve high success rates with the combined use of different techniques. Various factors, such as the presence of a self-limited cavity and the size of the cavity, are influential factors in the development of complications or treatment failure.

 

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Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
27 March 2025