CT Fluoroscopy-Guided Drain Placement to Treat Infected Gastric Leakage after Sleeve Gastrectomy: Technical and Clinical Outcome of 31 Procedures

Jens Schwarz; Frederik Franz Strobl; Philipp M Paprottka; Melvin D’Anastasi; Fritz W. Spelsberg; Markus Rentsch; Maximilian Reiser; Christoph Gregor Trumm

doi:10.1055/a-0977-3496

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, Inhaltsverzeichnis

Rofo 2020; 192(02): 163-170
DOI: 10.1055/a-0977-3496

Interventional Radiology

CT Fluoroscopy-Guided Drain Placement to Treat Infected Gastric Leakage after Sleeve Gastrectomy: Technical and Clinical Outcome of 31 Procedures

CT-fluoroskopisch gesteuerte Drainageneinlage in abdominelle Verhalte bei Nahtinsuffizienz nach Sleeve-Gastrektomien: technische und klinische Resultate von 31 Prozeduren

Jens Schwarz

¹Institute of Clinical Radiology, University Hospitals Munich – Campus Grosshadern, Ludwig-Maximilians-University Munich, Germany

,

Frederik Franz Strobl

¹Institute of Clinical Radiology, University Hospitals Munich – Campus Grosshadern, Ludwig-Maximilians-University Munich, Germany

,

Philipp M Paprottka

¹Institute of Clinical Radiology, University Hospitals Munich – Campus Grosshadern, Ludwig-Maximilians-University Munich, Germany

,

Melvin D’Anastasi

¹Institute of Clinical Radiology, University Hospitals Munich – Campus Grosshadern, Ludwig-Maximilians-University Munich, Germany

,

Fritz W. Spelsberg

²Institute of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany

,

Markus Rentsch

²Institute of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany

,

Maximilian Reiser

¹Institute of Clinical Radiology, University Hospitals Munich – Campus Grosshadern, Ludwig-Maximilians-University Munich, Germany

,

Christoph Gregor Trumm

³Institute of Diagnostic and Interventional Neuroradiology Ludwig-Maximilian-University, Munich, Germany

› Institutsangaben

Abstract

Purpose To observe the technical and clinical outcome as well as safety of CT fluoroscopy-guided drain placement in the multimodal clinical complication management of superinfected gastric leakage after sleeve gastrectomy.

Materials and Methods All consecutive patients who underwent CT fluoroscopy-guided drain placement to treat superinfected postoperative leakage after sleeve gastrectomy in our department between 2007 and 2014 were included in this retrospective study. All interventions were performed on a 16- or 128-row CT scanner under intermittent CT fluoroscopy guidance (15–25 mAs, 120 kV). The technical and clinical success rates as well as complications, additional therapies and patient radiation dose were analyzed.

Results 14 patients (mean age: 43.8 ± 11.3 years, mean BMI: 52.9 ± 13.5, 7 women) who underwent a total of 31 CT fluoroscopy-guided drain placement procedures were included. 30 of 31 interventions (96.8 %) were technically successful. 7 patients underwent more than one intervention due to drain obstruction or secondary dislocation or as further treatment. During and after the intervention no procedure-associated complications occurred. In all patients, inflammation parameters decreased within days after the CT-guided intervention. The total interventional dose length product (DLP) was 1561 ± 1035 mGy*cm.

Conclusion CT fluoroscopy-guided drain placement has been shown to be a safe minimally invasive procedure that rarely leads to complications for treating superinfected gastric leakage occurring after sleeve gastrectomy. We assume that operative revisions in a high-risk patient group can be avoided using this procedure.

Key Points:

CT fluoroscopy-guided drain placement in obese – often medically highly complex – patients is a technically feasible procedure.
Multimodal treatment (CT intervention, endoscopy and surgery) is required to successfully treat gastric leakage after bariatric surgery.
High-risk surgery might be avoided by the CT-guided drain placement.

Citation Format

Schwarz J, Strobl FF, Paprottka PM et al. CT Fluoroscopy-Guided Drain Placement to Treat Infected Gastric Leakage after Sleeve Gastrectomy: Technical and Clinical Outcome of 31 Procedures. Fortschr Röntgenstr 2020; 192: 163 – 170

Zusammenfassung

Ziel In dieser Studie wurden die technischen und klinischen Ergebnisse sowie die Sicherheit von CT-fluoroskopisch gesteuerten Drainageneinlagen in entzündete Verhalte bei Nahtinsuffizienz nach Sleeve-Gastrektomien als Teil eines multimodalen Komplikationsmanagements evaluiert.

Material und Methoden In diese retrospektive Studie wurden alle Patienten eingeschlossen, die zwischen 2007 und 2014 in unserer Abteilung eine CT-fluoroskopisch gesteuerte Drainageneinlage in entzündete Verhalte nach Sleeve-Gastrektomien erhalten haben. Alle Interventionen wurden auf einem 16- oder 128-Zeilen-CT unter intermittierender Fluoroskopie (15–25 mAs, 120 kV) durchgeführt. Technischer und klinischer Erfolg, die Patientenstrahlendosis (DLP), die Komplikationsrate und ergänzende Therapien wurden analysiert.

Ergebnisse 14 Patienten (Altersdurchschnitt 43,8 ± 11,3 Jahre, BMI 52,9 ± 13,5, 7 Frauen) wurden eingeschlossen, die insgesamt 31 CT-fluoroskopisch gesteuerte Drainagen erhalten haben. 30 der 31 Interventionen (96,8 %) waren technisch erfolgreich. Sieben Patienten erhielten mehr als eine Intervention aufgrund einer Drainageobstruktion, sekundärer Dislokationen oder als Verlaufstherapie. Peri- und postinterventionell traten keine interventionsbedingten Komplikationen auf. Bei allen Patienten fielen die laborchemischen Entzündungsparameter innerhalb von Tagen nach der Intervention. Das durchschnittliche gesamte Dosislängenprodukt einer Intervention lag bei 1561 ± 1035 mGy*cm.

Schlussfolgerung CT-fluoroskopisch gesteuerte Drainageneinlagen sind sichere, minimalinvasive und komplikationsarme Interventionen, um infizierte Verhalte nach Nahtinsuffizienzen bei Sleeve-Gastrektomien zu therapieren. Wir gehen davon aus, dass durch diese Interventionen komplexe Revisionsoperationen bei Hochrisikopatienten vermieden werden können.

Kernaussagen:

CT-fluoroskopisch gesteuerte Drainageneinlagen bei adipösen, oft multimorbiden Patienten sind eine technisch gut durchführbare Intervention.
Eine multidisziplinäre Behandlung (CT-Intervention, Endoskopie und Chirurgie) ist notwendig, um Nahtinsuffizienzen nach bariatrischer Chirurgie erfolgreich zu therapieren.
Hochrisiko-Revisionsoperationen könnten in vielen Fällen durch CT-gesteuerte Drainageneinlagen verhindert werden.

Key words

gastric leakage - drainage - fluoroscopy - sleeve gastrectomy

Volltext

Referenzen

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