Comparative Study between Surgical Intervention and Endoscopic Stenting for Management of Leakage after Sleeve Gastrectomy

Objectives: To evaluate surgical intervention versus stents insertion in management of staple line leaks after laparoscopic sleeve gastrectomy in morbidly obese patients.
Patients and methods: Prospective randomized study including 30 hemodynamically stable patients presented early post sleeve leaks discovered by routine postoperative imaging or during follow up period. Patients recruited from El-Demerdash university hospital and El Zahraa university hospital during period January 2014 to December 2018. Patients were divided in two equal ratio groups: Endoscopy group: included 15 patients post sleeve leakage underwent stent insertion and Surgery group: included 15 patients post sleeve leakage underwent surgical management.
Results: Mean interval between Initial surgery and leak in endoscopy group was 4.5±2.7 days with most common site of leak GE junction (80%). Mean interval between Initial surgery and leak in surgery group was 4.6±2.2 days; while most common site leak, GE junction (73.3%) with no statistical significance. Leak closure was achieved in 13 (86.66%) in  endoscopy group and only 2 patients required conversion R en Y with closure of leak and leak control within 3.3±5.5 days. Average hospital stay was 8.3 ±4.4 days. Leak closure achieved in 7 (46.6%) 13 (86.66%) in surgery group, seven patients required conversion to R en Y either from the start or after failure of direct suturing to control spillage, while one patients died. interval between closure of leak and leak control was 5 ±4.3 days. With average hospital stay 8.3 ±4.4  days. There was no statistically significant association between type of management and outcomes (p =0.51). In contrary, there was statistically significant association between type of management and interval for leak control (p <0.001) and hospital stay (p=0.012). There was no statistically significant association between the site of leak in both groups  (p=0.48).
Conclusion: Stenting is a better choice for spillage patients who are essentially steady. It is less dangerous than surgical procedure.