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Endoscopic Kehr’s T-Tube Placement to Treat Persistent Large Gastro-cutaneous Fistula After One Anastomosis Gastric Bypass: Video Demonstration
BACKGROUND: We aim to show the endoscopic placement of a T-tube to treat a persistent large gastro-cutaneous fistula after OAGB. METHODS: We present the case of a 46-year-old woman with BMI of 48 kg/m(2), who underwent OAGB and was re-operated on the 2nd postoperative day (POD) for leakage. Washing...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Springer US
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9613566/ https://www.ncbi.nlm.nih.gov/pubmed/36138314 http://dx.doi.org/10.1007/s11695-022-06285-5 |
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author | Liagre, Arnaud Queralto, Michel Combis, Jean Marc Peireira, Paulo Buchwald, Jane N. Martini, Francesco Petrucciani, Niccolo |
author_facet | Liagre, Arnaud Queralto, Michel Combis, Jean Marc Peireira, Paulo Buchwald, Jane N. Martini, Francesco Petrucciani, Niccolo |
author_sort | Liagre, Arnaud |
collection | PubMed |
description | BACKGROUND: We aim to show the endoscopic placement of a T-tube to treat a persistent large gastro-cutaneous fistula after OAGB. METHODS: We present the case of a 46-year-old woman with BMI of 48 kg/m(2), who underwent OAGB and was re-operated on the 2nd postoperative day (POD) for leakage. Washing and drainage of the abdominal cavity was performed, and no fistulous orifice was identified. An upper gastrointestinal (GI) endoscopy was performed at POD 20 for the persistence of leakage of 150 ml/day by the drain and a gastric fistulous orifice of 2 cm was detected. RESULTS: At POD 22, under general anesthesia, upper GI endoscopy was performed and a T-tube was placed in the fistulous orifice with a “rendez-vous” technique (as demonstrated in the Video), placing the T branch in the digestive lumen pressed against the wall and the long part of the T exiting at the cutaneous orifice. The T-tube was clamped after 3 days and the patient could be gradually re-fed. The patient was discharged 8 days after the procedure, with perfect clinical tolerance and no complications. The ablation of the tube one was performed on POD 84. No relapse occurred during a follow-up of 48 months. CONCLUSION: Persistent large gastro-cutaneous fistulas with an orifice bigger than 1 cm in diameter are difficult to manage. The endoscopic placement of a T-tube seems a useful option, which may facilitate the healing of the fistula. Further studies are needed to better define the role of this procedure. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11695-022-06285-5. |
format | Online Article Text |
id | pubmed-9613566 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer US |
record_format | MEDLINE/PubMed |
spelling | pubmed-96135662022-10-29 Endoscopic Kehr’s T-Tube Placement to Treat Persistent Large Gastro-cutaneous Fistula After One Anastomosis Gastric Bypass: Video Demonstration Liagre, Arnaud Queralto, Michel Combis, Jean Marc Peireira, Paulo Buchwald, Jane N. Martini, Francesco Petrucciani, Niccolo Obes Surg Multimedia Article BACKGROUND: We aim to show the endoscopic placement of a T-tube to treat a persistent large gastro-cutaneous fistula after OAGB. METHODS: We present the case of a 46-year-old woman with BMI of 48 kg/m(2), who underwent OAGB and was re-operated on the 2nd postoperative day (POD) for leakage. Washing and drainage of the abdominal cavity was performed, and no fistulous orifice was identified. An upper gastrointestinal (GI) endoscopy was performed at POD 20 for the persistence of leakage of 150 ml/day by the drain and a gastric fistulous orifice of 2 cm was detected. RESULTS: At POD 22, under general anesthesia, upper GI endoscopy was performed and a T-tube was placed in the fistulous orifice with a “rendez-vous” technique (as demonstrated in the Video), placing the T branch in the digestive lumen pressed against the wall and the long part of the T exiting at the cutaneous orifice. The T-tube was clamped after 3 days and the patient could be gradually re-fed. The patient was discharged 8 days after the procedure, with perfect clinical tolerance and no complications. The ablation of the tube one was performed on POD 84. No relapse occurred during a follow-up of 48 months. CONCLUSION: Persistent large gastro-cutaneous fistulas with an orifice bigger than 1 cm in diameter are difficult to manage. The endoscopic placement of a T-tube seems a useful option, which may facilitate the healing of the fistula. Further studies are needed to better define the role of this procedure. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11695-022-06285-5. Springer US 2022-09-22 2022 /pmc/articles/PMC9613566/ /pubmed/36138314 http://dx.doi.org/10.1007/s11695-022-06285-5 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Multimedia Article Liagre, Arnaud Queralto, Michel Combis, Jean Marc Peireira, Paulo Buchwald, Jane N. Martini, Francesco Petrucciani, Niccolo Endoscopic Kehr’s T-Tube Placement to Treat Persistent Large Gastro-cutaneous Fistula After One Anastomosis Gastric Bypass: Video Demonstration |
title | Endoscopic Kehr’s T-Tube Placement to Treat Persistent Large Gastro-cutaneous Fistula After One Anastomosis Gastric Bypass: Video Demonstration |
title_full | Endoscopic Kehr’s T-Tube Placement to Treat Persistent Large Gastro-cutaneous Fistula After One Anastomosis Gastric Bypass: Video Demonstration |
title_fullStr | Endoscopic Kehr’s T-Tube Placement to Treat Persistent Large Gastro-cutaneous Fistula After One Anastomosis Gastric Bypass: Video Demonstration |
title_full_unstemmed | Endoscopic Kehr’s T-Tube Placement to Treat Persistent Large Gastro-cutaneous Fistula After One Anastomosis Gastric Bypass: Video Demonstration |
title_short | Endoscopic Kehr’s T-Tube Placement to Treat Persistent Large Gastro-cutaneous Fistula After One Anastomosis Gastric Bypass: Video Demonstration |
title_sort | endoscopic kehr’s t-tube placement to treat persistent large gastro-cutaneous fistula after one anastomosis gastric bypass: video demonstration |
topic | Multimedia Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9613566/ https://www.ncbi.nlm.nih.gov/pubmed/36138314 http://dx.doi.org/10.1007/s11695-022-06285-5 |
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