Year 2021 / Volume 113 / Number 10
Original
Endoscopic internal drainage using transmural double-pigtail stents in leaks following upper gastrointestinal tract surgery

698-703

DOI: 10.17235/reed.2020.7514/2020

Esteban Fuentes-Valenzuela, Francisco Javier García-Alonso, Javier Tejedor-Tejada, Rodrigo Nájera-Muñoz, Marina de Benito Sanz, Ramón Sánchez-Ocaña, Carlos de la Serna Higuera, Manuel Pérez-Miranda,

Abstract
Introduction: different endoscopic procedures have been proposed for the management of surgical leaks. Endoscopic internal drainage using trans-fistulary double-pigtail plastic stents has emerged as an alternative strategy, especially in fistulae presenting after laparoscopic gastric sleeve. Methods: a retrospective case series was performed at a single tertiary care center including all upper gastrointestinal post-surgical leaks primarily managed with endoscopic trans-fistulary insertion of double-pigtail plastic stents. Clinical success was defined as the absence of extravasation of oral radiographic contrast and radiological resolution of the collection with adequate oral intake Results: nine patients were included, six (66.6 %) females with a median age of 52.6 years (IQR 47-60). Five cases presented after laparoscopic gastric sleeve, two cases after distal esophagectomies, one after a Roux-en-Y gastric bypass and another one after a pancreaticoduodenectomy. Fistulae measured < 10 mm in five patients (55.6 %) and 10-20 mm in four patients (44.4 %). Six were early leaks. Technical and clinical success was achieved in nine (100 %) and seven (77.8 %) cases, respectively. Seven (77.8 %) patients required ≤ 3 endoscopic procedures. The median hospital stay after the first endoscopic procedure was 12 days (IQR 6.5-17.5 days), while the overall median time until leak healing was 118.5 days (IQR 84.5-170). One patient with a post-esophagectomy intrathoracic leak developed an esophageal-tracheal fistula 37 days after stent deployment. Conclusions: our results support the use of endoscopic internal drainage in postsurgical abdominal leaks, regardless of the type of surgery. Although only two patients with intrathoracic dehiscence were included.
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Fuentes-Valenzuela E, García-Alonso F, Tejedor-Tejada J, Nájera-Muñoz R, de Benito Sanz M, Sánchez-Ocaña R, et all. Endoscopic internal drainage using transmural double-pigtail stents in leaks following upper gastrointestinal tract surgery. 7514/2020


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Publication history

Received: 08/09/2020

Accepted: 16/11/2020

Online First: 29/12/2020

Published: 06/10/2021

Article revision time: 63 days

Article Online First time: 112 days

Article editing time: 393 days


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