Leaks following sleeve gastrectomy represent a serious problem for surgeons, since a standardized approach has not yet been established.
Usually laparoscopic exploration is necessary in order to achieve a diagnostic peritoneal lavage, and a surgical drain is left in place proximally to the suture line, at the level of the dehiscence (if visualized), jejunostomy is also frequently performed to ensure enteral alimentation. This treatment however, needs to be combined with an endoscopic treatment, in order to facilitate rapid closure of gastric staple line defects.
In this video we report our Endoscopic Internal Drainage (EID) technique by insertion of double pigtail stents combined for the firsts weeks with enteral nutrition, with the aim to create an internal fistula allowing to quickly remove the surgical drain, and promote the formation of granulation tissue at the level of the dehiscence.
Endoscopic internal drainage with enteral nutrition (EDEN) for treatment of leaks following sleeve gastrectomy. Donatelli G, Ferretti S, Vergeau BM, Dhumane P, Dumont JL, Derhy S, Tuszynski T, Dritsas S, Carloni A, Catheline JM, Pourcher G, Dagher I, Meduri B. Obes Surg 2014;24:1400-7.