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Endoscopic internal drainage of gastric fistula after sleeve gastrectomy

Gf Donatelli, MD S Perretta, MD, PhD M Ignat, MD, PhD M Pizzicannella, MD D Mutter, MD, PhD, FACS J Marescaux, MD, FACS, Hon FRCS, Hon FJSES, Hon FASA, Hon APSA
Epublication WebSurg.com, Feb 2019;19(02). URL: http://websurg.com/doi/vd01en5548

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  • 2019-02-19
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Gastric fistula is a major adverse event after sleeve gastrectomy. In this live instructional video, authors present the case of a 45-year-old woman with a complex postoperative course after sleeve gastrectomy due to a gastric leakage and a twisted stomach. The patient had already been managed with the endoscopic placement of a fully covered metal stent and a percutaneous drainage with no resolution of the fistula. The first step of the procedure consists in the removal of a 16cm fully covered stent using a grasper. After contrast injection, the leakage and the gastric twist are visualized. Under fluoroscopic control, a 30mm pneumatic dilatation of the twist is obtained. Two double pigtail plastic stents are placed between the stomach and the abscess cavity in order to achieve internal drainage and facilitate the healing process. The percutaneous drainage will be removed one day after the procedure while the plastic stents will be removed after 3 months.