Endoscopic Abscess Septotomy: A Less Invasive Approach for the Treatment of Sleeve Gastrectomy Leaks

摘要

Background: Postoperative leaks develop in a low percentage of patients undergoing laparoscopic sleeve gastrectomy (LSG), representing a rare yet devastating postoperative complication increasing morbidity and hospital stay. Leaks can become collections and may be very difficult to manage. Several therapeutic options with variable results, including surgical and nonsurgical methods have been described. Endoscopic abscess septotomy is an alternative method recently performed by a few centers reporting efficacy and safety outcomes. The purpose of this report is to present our successful experience with endoscopic abscess septotomy for the treatment of postsleeve gastrectomy leaks. Methods: Two female patients with post-LSG leaks and abscess formation diagnosed 4 weeks postprocedure, initially managed with diagnostic laparoscopy, peritoneal washout, and drain placement with poor improvement, were chosen for endoscopic abscess septotomy with concomitant lumen dilation and sleeve axis rectification. Results: Endoscopic abscess septotomy was successfully performed in both patients with no complications. Clinical and radiological resolutions were accomplished at 10 and 12 weeks, respectively, postseptotomy. Conclusion: This endoscopic approach is a feasible and effective method for the treatment of leaks and collections after LSG. Concomitant balloon dilation of the gastric sleeve improves gastric emptying and reduces intraluminal pressure, hence favoring tissue healing and leak resolution.