期刊
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES
卷 36, 期 9, 页码 6439-6445出版社
SPRINGER
DOI: 10.1007/s00464-021-08992-z
关键词
Obesity; Bariatric surgery; Obesity surgery; Laparoscopic sleeve gastrectomy; Fistula; Endoscopic full-thickness resection; Purse-string suture
类别
This observational study reports the efficacy and safety of endoscopic full-thickness resection combined with purse-string sutures in treating postoperative fistula after laparoscopic sleeve gastrectomy. The results showed that this innovative endoscopic strategy is safe, effective, and allows early oral feeding.
Background Postoperative fistula is a life-threatening complication that lacks a standard treatment strategy after laparoscopic sleeve gastrectomy (LSG). This observational study is the first to report the efficacy and safety of endoscopic full-thickness resection (EFTR) combined with purse-string sutures in treating this complication. Patients and methods The old fistula was resected by EFTR, cut radially, and then sutured with a purse-string. The primary endpoint was complete fistula closure within two months. Endoscopic procedure-related complications were also recorded. Results Eight of 788 LSG patients developed fistulas with an incidence of 1.01%, primarily under the gastroesophageal junction, and the average distance from the center of the fistula to the cardia was 30 +/- 6.3 mm. Two patients were cured by conservative treatment, and six received endoscopic sutures. The time from LSG to fistula diagnosis was 12.3 +/- 14.4 days. The time from fistula diagnosis to endoscopic repair was 43.8 +/- 55.8 days and 21.4 +/- 10.0 days after eliminating the data of first case. The average fistula size was 12 +/- 10 mm, the average endoscopic procedure duration was 40 +/- 16 min, and the average number of endoscopic procedures required was 1.6 +/- 0.8. Five patients achieved the primary endpoint, and one patient refused a third endoscopic suture after two sutures. The endoscopy success rate was 83.3%. No endoscopic procedure-related complications occurred. Conclusions EFTR combined with purse-string sutures is an innovative, safe, and effective endoscopic strategy for postoperative fistula after LSG, avoiding reoperation and allowing early oral feeding.
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