Stents can help manage leaks after bariatric surgery

Last Updated: 2018-10-02

By Will Boggs MD

NEW YORK (Reuters Health) - Stent placement can be effective for managing postoperative leaks after bariatric surgery, according to a database analysis.

Endoscopically placed stents are used in general and oncologic surgery to manage esophageal obstructions, fistulas and leaks. But there is limited evidence of their use for managing bariatric postoperative leaks.

Dr. Arielle E. Kanters and colleagues from the University of Michigan, in Ann Arbor, used data from the 2015 and 2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) participant files to evaluate the rates of use and efficacy of stent placement for postoperative leak following bariatric surgery.

Of more than 354,000 cases, 0.3% developed an anastomotic or staple line leak. Overall, 275 of these patients (24%) were treated with an endoscopically placed stent, the researchers report in the Annals of Surgery, online September 20.

Sixty-one percent of these patients were successfully treated with a stent alone, whereas the remainder also required operative intervention. Most of these interventions (80.4%) occurred after stent placement.

Patients successfully treated with a stent alone had significantly lower rates of unplanned ICU readmission (18.5%), compared with patients successfully treated with reoperation alone (36.1%), but higher rates of 30-day readmission (79.8% versus 59.0%, respectively).

"It is important to remain mindful of the significant tradeoffs associated with use of these devices, including increased interventions and likelihood of readmission," the researchers conclude. "These must be considered when counseling patients and choosing a management pathway when confronted with a leak in order to minimize the likelihood of additional resource utilization."

Dr. Hany Shehab from Kasr Alaini School of Medicine at Cairo University in Egypt, who has studied the use of enteral stents in the management of post-bariatric surgery leaks, told Reuters Health by email, "To me, there is no question comparing stent placement to operative intervention. Reoperation is only indicated as a drainage procedure (not to repair the leak) or after failure of all endoscopic modalities. The question is not surgery versus stents; it's stents versus other noninvasive methods, such as double pigtails, clips, or vacuum therapy."

"The take-home message from the study is that stents do necessitate several procedures, and current stent design is far from optimal, but in the end they are effective in saving patients' lives and do avoid several very morbid surgical interventions," said Dr. Shehab, who was not involved in the study.

Dr. Kanters did not respond to a request for comments.

SOURCE: https://bit.ly/2RpyuMq

Ann Surg 2018.