Purpose Post-bariatric surgery gastrocutaneous fistula is a chronic leak with an incidence of 1.7 to 4.0% and no standardized management. A large gastrocutaneous fistula (LGCF) is not indicated for treatment with pigtail drains. We aimed to evaluate results of a novel treatment using endoscopic Kehr's T-tube placement.Methods Only patients with a postoperative LGCF duration of >10 days and a flow rate of > 50 cc by external drainage after revisional surgery for sepsis were included. Endoscopic placement of Kehr's T-tube was performed. Patients had been reoperated with wash and drainage for severe sepsis after initial bariatric surgery in which no fistula had been discovered. Patients not reoperated, or with a fistula requiring intraoperative Kehr's T-tube placement, or a pigtail drain were excluded. Primary outcomes were endoscopic characteristics and results (LGCF closure rate, Kehr T-tube retention time, etc.).Results The study group included 12 women, 2 men; body mass index 43.1 +/- 4.5 kg/m(2). Interventions were SG (7), RYGB (2), OAGB (4), and SADI-S (1). Endoscopic assessment was carried out after a mean of 33.2 +/- 44.3 days after the bariatric procedure. The mean fistula orifice diameter was 2.0 +/- 0.9 cm. Kehr's T-tube was positioned at a mean 51.5 +/- 54.8 days after the bariatric procedure. T-tube tolerance was excellent. Mean additional days: hospitalization, 34.4 +/- 27.0; T-tube retention, 86.4 +/- 73.1; fistula healing, 139.9 +/- 111.5,LGCF closure rate, 92.9%. Complications: 1 pulmonary embolism, 2 T-tube migrations,1 drain-path bleed, 1 skin abscess. No mortality.Conclusions Endoscopic Kehr's T-tube placement was successful in closing persistent post-bariatric surgery LGCF in 92.9% of patients.
Treatment of Persistent Large Gastrocutaneous Fistulas After Bariatric Surgery. Preliminary Experience with Endoscopic Kehr's T-Tube Placement / Liagre, Arnaud; Queralto, Michel; Levy, Jonathan; Combis, Jean Marc; Peireira, Paulo; Buchwald, Jane N; Juglard, Gildas; Petrucciani, Niccolo; Martini, Francesco. - In: OBESITY SURGERY. - ISSN 0960-8923. - 32:4(2022), pp. 1377-1384. [10.1007/s11695-022-05935-y]
Treatment of Persistent Large Gastrocutaneous Fistulas After Bariatric Surgery. Preliminary Experience with Endoscopic Kehr's T-Tube Placement
Petrucciani, Niccolo
;
2022
Abstract
Purpose Post-bariatric surgery gastrocutaneous fistula is a chronic leak with an incidence of 1.7 to 4.0% and no standardized management. A large gastrocutaneous fistula (LGCF) is not indicated for treatment with pigtail drains. We aimed to evaluate results of a novel treatment using endoscopic Kehr's T-tube placement.Methods Only patients with a postoperative LGCF duration of >10 days and a flow rate of > 50 cc by external drainage after revisional surgery for sepsis were included. Endoscopic placement of Kehr's T-tube was performed. Patients had been reoperated with wash and drainage for severe sepsis after initial bariatric surgery in which no fistula had been discovered. Patients not reoperated, or with a fistula requiring intraoperative Kehr's T-tube placement, or a pigtail drain were excluded. Primary outcomes were endoscopic characteristics and results (LGCF closure rate, Kehr T-tube retention time, etc.).Results The study group included 12 women, 2 men; body mass index 43.1 +/- 4.5 kg/m(2). Interventions were SG (7), RYGB (2), OAGB (4), and SADI-S (1). Endoscopic assessment was carried out after a mean of 33.2 +/- 44.3 days after the bariatric procedure. The mean fistula orifice diameter was 2.0 +/- 0.9 cm. Kehr's T-tube was positioned at a mean 51.5 +/- 54.8 days after the bariatric procedure. T-tube tolerance was excellent. Mean additional days: hospitalization, 34.4 +/- 27.0; T-tube retention, 86.4 +/- 73.1; fistula healing, 139.9 +/- 111.5,LGCF closure rate, 92.9%. Complications: 1 pulmonary embolism, 2 T-tube migrations,1 drain-path bleed, 1 skin abscess. No mortality.Conclusions Endoscopic Kehr's T-tube placement was successful in closing persistent post-bariatric surgery LGCF in 92.9% of patients.File | Dimensione | Formato | |
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