Endoscopic management of bariatric complications： Areview and update

• 作者: Caolan Walsh Shahzeer Karmali.
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: BARIATRIC surgery BARIATRIC COMPLICATIONS Endoscopic treatment Sleeve GASTRECTOMY Roux-en-Ygastric BYPASS Anastomotic LEAK Self-expanding metalstent
• 年，卷（期）: 2015,（5）
• 页码范围: 518-523
• 页数: 6页
• 分类号: R

摘要

With over a third of Americans being considered obese,bariatric procedures have now become the mostperformed operation be general surgeons in theUnited States. The most common operations are theLaparoscopic Roux-en-Y Gastric Bypass, the LaparoscopicSleeve Gastrectomy, and the LaparoscopicAdjustable Gastric Band. With over 340000 bariatricprocedures preformed worldwide in 2011, the absolutenumber of complications related to these operationsis also increasing. Complications, although few, canbe life threatening. One of the most dreaded acutecomplication is the anastomotic/staple line leak. If leftundiagnosed or untreated they can lead to sepsis, multiorgan failure, and death. Smaller or contained leaks candevelop into fistulas. Although most patients with anacute anastomotic leak return to the operating room,there has been a trend to manage the stable patientwith an endoscopic stent. They offer an advantageby creating a barrier between enteric content and theleak, and will allow the patients to resume enteralfeeding much earlier. Fistulas are a complex andchronic complication with high morbidity and mortality.Postoperative bleeding although rare may also betreated locally with endoscopy. Stenosis is a morefrequent late complication and is best-managed withendoscopic therapy. Stents may not heal every fistula orstenosis, however they may prevent certain patients theneed for additional revisional surgery.