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Is the Surgical Drainage Mandatory for Leak after Sleeve Gastrectomy?

Introduction: Despite the unanimous acknowledgement of the laparoscopic sleeve gastrectomy (LSG) worldwide, the leak remains its deficiency. For the last decade, the surgical treatment was practically considered mandatory for almost any collection following LSG. The aim of this study is to evaluate...

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Autores principales: Nedelcu, Marius, Manos, Thierry, Noel, Patrick, Danan, Marc, Zulian, Viola, Vilallonga, Ramon, Nedelcu, Anamaria, Carandina, Sergio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9963979/
https://www.ncbi.nlm.nih.gov/pubmed/36835912
http://dx.doi.org/10.3390/jcm12041376
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author Nedelcu, Marius
Manos, Thierry
Noel, Patrick
Danan, Marc
Zulian, Viola
Vilallonga, Ramon
Nedelcu, Anamaria
Carandina, Sergio
author_facet Nedelcu, Marius
Manos, Thierry
Noel, Patrick
Danan, Marc
Zulian, Viola
Vilallonga, Ramon
Nedelcu, Anamaria
Carandina, Sergio
author_sort Nedelcu, Marius
collection PubMed
description Introduction: Despite the unanimous acknowledgement of the laparoscopic sleeve gastrectomy (LSG) worldwide, the leak remains its deficiency. For the last decade, the surgical treatment was practically considered mandatory for almost any collection following LSG. The aim of this study is to evaluate the need for surgical drainage for leak following LSG. Methods: All consecutive patients having gone through LSG from January 2017 to December 2020 were enrolled in our study. Once the demographic data and the leak history were registered, we analyzed the outcome of the surgical or endoscopic drainage, the characteristics of the endoscopic treatment, and the evolution to complete healing. Results: A total of 1249 patients underwent LSG and the leak occurred in 11 cases (0.9%). There were 10 women with a mean age of 47.8 years (27–63). The surgical drainage was performed for three patients and the rest of the eight patients underwent primary endoscopic treatment. The endoscopic treatment was represented with pigtails for seven cases and septotomy with balloon dilation for four cases. In two out of these four cases, the septotomy was anticipated by the use of a nasocavitary drain for 2 weeks. The average number of endoscopic procedures was 3.2 (range 2–6). The leaks achieved complete healing after an average duration of 4.8 months (range 1–9 months). No mortality was recorded for a leak. Conclusions: The treatment of the gastric leak must be tailored to each patient. Although there is still no consensus for the endoscopic drainage of leaks after LSG, the surgical approach can be avoided in up to 72%. The benefits of pigtails and nasocavitary drains followed by endoscopic septotomy are undeniable, and they should be included in the armamentarium of any bariatric center.
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spelling pubmed-99639792023-02-26 Is the Surgical Drainage Mandatory for Leak after Sleeve Gastrectomy? Nedelcu, Marius Manos, Thierry Noel, Patrick Danan, Marc Zulian, Viola Vilallonga, Ramon Nedelcu, Anamaria Carandina, Sergio J Clin Med Article Introduction: Despite the unanimous acknowledgement of the laparoscopic sleeve gastrectomy (LSG) worldwide, the leak remains its deficiency. For the last decade, the surgical treatment was practically considered mandatory for almost any collection following LSG. The aim of this study is to evaluate the need for surgical drainage for leak following LSG. Methods: All consecutive patients having gone through LSG from January 2017 to December 2020 were enrolled in our study. Once the demographic data and the leak history were registered, we analyzed the outcome of the surgical or endoscopic drainage, the characteristics of the endoscopic treatment, and the evolution to complete healing. Results: A total of 1249 patients underwent LSG and the leak occurred in 11 cases (0.9%). There were 10 women with a mean age of 47.8 years (27–63). The surgical drainage was performed for three patients and the rest of the eight patients underwent primary endoscopic treatment. The endoscopic treatment was represented with pigtails for seven cases and septotomy with balloon dilation for four cases. In two out of these four cases, the septotomy was anticipated by the use of a nasocavitary drain for 2 weeks. The average number of endoscopic procedures was 3.2 (range 2–6). The leaks achieved complete healing after an average duration of 4.8 months (range 1–9 months). No mortality was recorded for a leak. Conclusions: The treatment of the gastric leak must be tailored to each patient. Although there is still no consensus for the endoscopic drainage of leaks after LSG, the surgical approach can be avoided in up to 72%. The benefits of pigtails and nasocavitary drains followed by endoscopic septotomy are undeniable, and they should be included in the armamentarium of any bariatric center. MDPI 2023-02-09 /pmc/articles/PMC9963979/ /pubmed/36835912 http://dx.doi.org/10.3390/jcm12041376 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Nedelcu, Marius
Manos, Thierry
Noel, Patrick
Danan, Marc
Zulian, Viola
Vilallonga, Ramon
Nedelcu, Anamaria
Carandina, Sergio
Is the Surgical Drainage Mandatory for Leak after Sleeve Gastrectomy?
title Is the Surgical Drainage Mandatory for Leak after Sleeve Gastrectomy?
title_full Is the Surgical Drainage Mandatory for Leak after Sleeve Gastrectomy?
title_fullStr Is the Surgical Drainage Mandatory for Leak after Sleeve Gastrectomy?
title_full_unstemmed Is the Surgical Drainage Mandatory for Leak after Sleeve Gastrectomy?
title_short Is the Surgical Drainage Mandatory for Leak after Sleeve Gastrectomy?
title_sort is the surgical drainage mandatory for leak after sleeve gastrectomy?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9963979/
https://www.ncbi.nlm.nih.gov/pubmed/36835912
http://dx.doi.org/10.3390/jcm12041376
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