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Use of sleeve-customized self-expandable metal stents for the treatment of staple-line leakage after laparoscopic sleeve gastrectomy

  • Author Footnotes
    ∗ Drs Fishman and Shnell contributed equally to this article.
    Sigal Fishman
    Correspondence
    Reprint requests: Dr. Sigal Fishman, MD, Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, 64239 Israel.
    Footnotes
    ∗ Drs Fishman and Shnell contributed equally to this article.
    Affiliations
    Obesity Service, Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
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  • Author Footnotes
    ∗ Drs Fishman and Shnell contributed equally to this article.
    Mati Shnell
    Footnotes
    ∗ Drs Fishman and Shnell contributed equally to this article.
    Affiliations
    Obesity Service, Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
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  • Nathan Gluck
    Affiliations
    Obesity Service, Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
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  • Shmuel Meirsdorf
    Affiliations
    Department of Imaging, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
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  • Subhi Abu-Abeid
    Affiliations
    Bariatric Unit, Department of Surgery, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
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  • Erwin Santo
    Affiliations
    Obesity Service, Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
    Search for articles by this author
  • Author Footnotes
    ∗ Drs Fishman and Shnell contributed equally to this article.
Published:February 28, 2015DOI:https://doi.org/10.1016/j.gie.2014.11.012
      Bariatric procedures have emerged as a leading therapeutic approach in morbidly obese patients. Laparoscopic sleeve gastrectomy (LSG) was originally introduced as a bridge procedure before Roux-en-Y gastric bypass (RYGB) but has subsequently become a definitive procedure after demonstrating similar efficacy to that of RYGB for inducing weight loss.
      • D'Hondt M.
      • Vanneste S.
      • Pottel H.
      • et al.
      Laparoscopic sleeve gastrectomy as a single-stage procedure for the treatment of morbid obesity and the resulting quality of life, resolution of comorbidities, food tolerance, and 6-year weight loss.
      Moreover, LSG has demonstrated a good safety profile and is less technically demanding than RYGB.
      • Silecchia G.
      • Boru C.
      • Pecchia A.
      • et al.
      Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients.
      • Schauer P.R.
      • Kashyap S.R.
      • Wolski K.
      • et al.
      Bariatric surgery versus intensive medical therapy in obese patients with diabetes.
      However, LSG is prone to some adverse events because of the long staple line and elevated intragastric pressure.
      • Yehoshua R.T.
      • Eidelman L.A.
      • Stein M.
      • et al.
      Laparoscopic sleeve gastrectomy—volume and pressure assessment.
      These include staple-line leakage, bleeding, and sleeve stricture.
      • Yehoshua R.T.
      • Eidelman L.A.
      • Stein M.
      • et al.
      Laparoscopic sleeve gastrectomy—volume and pressure assessment.
      The prevalence of staple-line leaks has been as high as 20% in some reports, but a more traditional estimate is 1% to 9%.
      • Moszkowicz D.
      • Arienzo R.
      • Khettab I.
      • et al.
      Sleeve gastrectomy severe complications: is it always a reasonable surgical option?.
      • Rosenthal R.J.
      • International Sleeve Gastrectomy Expert Panel
      • Diaz A.A.
      • et al.
      International Sleeve Gastrectomy Expert Panel consensus statement: best practice guidelines based on experience of >12,000 cases.
      The onset of leaks is defined as acute, early, late, or chronic depending on the time interval since surgery: up to 1 week, 1 to 6 weeks, 6 to 12 weeks, and more than 12 weeks, respectively.
      • Rosenthal R.J.
      • International Sleeve Gastrectomy Expert Panel
      • Diaz A.A.
      • et al.
      International Sleeve Gastrectomy Expert Panel consensus statement: best practice guidelines based on experience of >12,000 cases.

      Abbreviations:

      LSG (laparoscopic sleeve gastrectomy), RYGB (Roux-en-Y gastric bypass), SEMS (self-expandable metal stent), S-SEMS (sleeve-customized self-expandable metallic stent)
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