Choosing the best endoscopic approach for post-bariatric surgical leaks and fistulas: Basic principles and recommendations

Post-surgical leaks and fistulas are the most feared complication of bariatric surgery. They have become more common in clinical practice given the increasing number of these procedures and can be very difficult to treat. These two related conditions must be distinguished and characterized to guide...

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Bibliographic Details
Published in:World journal of gastroenterology : WJG 2023-02, Vol.29 (7), p.1173-1193
Main Authors: de Oliveira, Victor Lira, Bestetti, Alexandre Moraes, Trasolini, Roberto Paolo, de Moura, Eduardo Guimarães Hourneaux, de Moura, Diogo Turiani Hourneaux
Format: Article
Language:English
Subjects:
Anastomotic Leak - etiology
Anastomotic Leak - surgery
Bariatric Surgery - adverse effects
Drainage - adverse effects
Endoscopy - adverse effects
Endoscopy - methods
Fistula - complications
Fistula - surgery
Humans
Minireviews
Retrospective Studies
Treatment Outcome
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Summary:Post-surgical leaks and fistulas are the most feared complication of bariatric surgery. They have become more common in clinical practice given the increasing number of these procedures and can be very difficult to treat. These two related conditions must be distinguished and characterized to guide the appropriate treatment. Leak is defined as a transmural defect with communication between the intra and extraluminal compartments, while fistula is defined as an abnormal communication between two epithelialized surfaces. Traditionally, surgical treatment was the preferred approach for leaks and fistulas and was associated with high morbidity with significant mortality rates. However, with the development of novel devices and techniques, endoscopic therapy plays an increasingly essential role in managing these conditions. Early diagnosis and endoscopic therapy initiation after clinical stabilization are crucial to success since clinical success rates are higher for acute leaks and fistulas when compared to late and chronic leaks and fistulas. Several endoscopic techniques are available with different mechanisms of action, including direct closure, covering/diverting or draining. The treatment should be individualized by considering the characteristics of both the patient and the defect. Although there is a lack of high-quality studies to provide standardized treatment algorithms, this narrative review aims to provide a summary of the current scientific evidence and, based on this data and our extensive experience, make recommendations to help choose the best endoscopic approach for the management of post-bariatric surgical leaks and fistulas.
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v29.i7.1173