ENDOSCOPIC PERORAL DRAINAGE (EPOD) OF PERITONEAL POST BARIATRIC SURGERY COLLECTION AND ABSCESSES

Aims:

Pancreatic collections endodrainage is a rationale for Endoscopic Peroral Drainage (EPOD) in cases of peritoneal abscess after Bariatric surgery leaks. Reoperation has a high morbidity and CTdrainage has limitations.

Methods:

We included 80 consecutive patients from 2007 to 2015 (48 Sleeve gastrectomy, 32 gastric bypass) with post operative leaks between 5 to 21 days. Patients Heart rate was over 120 bpm. Tomography showed left sub-phrenic, peri-gastric or free abdominal collections. Upper CO2 endoscopy allowed trough the leak acces to peritoneum (9,8 or 5,8 mm diameter gastroscope). In patients with orifices < 5.8 mm balloon dilatation of the leak was performed. The abssces content was suctioned out (100 to 700 ml) and sample taken for bacterial culture. Cavity was flushed and cleaned with sterile saline (200 – 2000 ml). If needed surgical drains were repositioned or replaced using endoscopic forceps and snares by one of the following approaches: 1- advancing endoscopes to the skin orifice, pulling the drains tubes into the peritoneum and leave them close to the leak. 2-searching for one laparoscopic port inside peritoneum, re-opening it under endoscopic visión, advancing through it drainage catheters and pulling back to place them close to the leak. In 8 patients fórceps or knifes endoscopic liberation of ahdesions was required. Leaks were treated with SEMS.

Results:

Heart rate returned to normal within 24 hours. In 50% of patients it hapenned immediately after drainage. Average time was 55 minutes. Abdominal catheters were removed between 7 and 18 days once full resolution of the debit was achieved. Twenty patients were discharged within the first 24 hours and the rest between wtithin 8 days. SEMS were placed for 6 to 8 weeks leading to complete closure of leaks. There were no adverse events.

Conclusion:

EPOD for peritoneal abscesses secondary to Bariatric surgery leaks is feasible, safe and highly effective.