RSS-Feed abonnieren
DOI: 10.1055/s-0029-1214606
© Georg Thieme Verlag KG Stuttgart · New York
Endoscopic treatment of postoperative enterocutaneous fistulas after bariatric surgery with the use of a fistula plug: report of five cases
Publikationsverlauf
submitted 3 September 2008
accepted after revision 24 February 2009
Publikationsdatum:
16. Juni 2009 (online)
Anastomotic leaks frequently occur after bariatric surgery and their management includes different options. The present study describes the management of enterocutaneous fistulas in patients in whom surgical or endoscopic treatments have failed, by insertion of a biomaterial (Surgisis fistula plug) to facilitate healing of the gastrocutaneous fistula. Five patients with leaks after bariatric surgery were treated. All patients had undergone previous failed surgical or endoscopic attempt(s) at closure. Our technique entailed insertion of the Surgisis fistula plug into the fistula tract by a ”rendezvous” procedure, via both percutaneous and endoscopic routes. The data were collected retrospectively. Initially, two patients were treated by fistula plug alone and three received fistula plug plus a self-expanding stent. In two patients, cutaneous fistula outflow ceased within a few days. The other three patients required one additional endoscopic procedure. At the end we observed healed leaks in four of the five patients (80 %). The median follow-up duration was 18 months. In conclusion, the combined therapy consisting of fistula plug implantation with optional stenting helps closure in these difficult refractory cases of gastrocutaneous fistula.
References
- 1 Colquitt J, Clegg A, Loveman E. et al . Surgery for morbid obesity. Cochrane Database Syst Rev. 2005; 4 CD003641
- 2 Gonzalez R, Sarr M G, Smith C D. et al . Diagnosis and contemporary management of anastomotic leaks after gastric bypass for obesity. J Am Coll Surg. 2007; 204 47-55
- 3 Eisendrath P, Cremer M, Himpens J. et al . Endotherapy including temporary stenting of fistulae of the upper gastrointestinal tract after laparoscopic bariatric surgery. Endoscopy. 2007; 39 625-630
- 4 Ansaloni L, Cambrini P, Catena F. et al . Immune response to small intestinal submucosa (surgisis) implant in humans: preliminary observations. J Invest Surg. 2007; 20 237-241
- 5 Franklin Jr M E, Treviño J M, Portillo G. et al . The use of porcine small intestinal submucosa as a prosthetic material for laparoscopic hernia repair in infected and potentially contaminated fields: long-term follow-up. Surg Endosc. 2008; 22 1941-1946
- 6 Alpert S A, Cheng E Y, Kaplan W E. et al . Bladder neck fistula after the complete primary repair of exstrophy: a multi-institutional experience. J Urol. 2005; 174 1687-1689; discussion 1689 – 1690
- 7 Champagne B J, O’Connor L M, Ferguson M. et al . Efficacy of anal fistula plug in closure of cryptoglandular fistulas: long-term follow-up. Dis Colon Rectum. 2006; 49 1817-1821
- 8 Johnson E K, Gaw J U, Armstrong D N. Efficacy of anal fistula plug vs. fibrin glue in closure of anorectal fistulas. Dis Colon Rectum. 2006; 49 371-376
- 9 Pross M, Manger T, Reinheckel T. et al . Endoscopic treatment of clinically symptomatic leaks of thoracic esophageal anastomoses. Gastrointest Endosc. 2000; 51 73-76
- 10 Truong S, Böhm G, Klinge U. et al . Results after endoscopic treatment of postoperative upper gastrointestinal fistulas and leaks using combined Vicryl plug and fibrin glue. Surg Endosc. 2004; 18 1105-1108
E. Toussaint, MD
Department of Gastroenterology, Hepatopancreatology and Digestive Oncology
Erasme Hospital
808 Route de Lennik
1070 Brussels
Belgium
Fax: +32–2-5554697
eMail: emmanuel.toussaint@bordet.be