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Review
. 2023 May 16;12(10):3495.
doi: 10.3390/jcm12103495.

Treatments for Staple Line Leakage after Laparoscopic Sleeve Gastrectomy

Takashi Oshiro  1 , Kotaro Wakamatsu  1 , Taiki Nabekura  1 , Yuki Moriyama  1 , Natsumi Kitahara  1 , Kengo Kadoya  1 , Ayami Sato  1 , Tomoaki Kitahara  1 , Tasuku Urita  1 , Yu Sato  1 , Makoto Nagashima  1 , Masaru Tsuchiya  1 , Shinichi Okazumi  1
Affiliations
Review

Treatments for Staple Line Leakage after Laparoscopic Sleeve Gastrectomy

Takashi Oshiro et al. J Clin Med. .

Abstract

The number of laparoscopic sleeve gastrectomies (LSGs) performed in patients with obesity who are eligible for bariatric and metabolic surgery is currently much lower in Japan than in other countries. Considering the large number of potential patients with obesity and type 2 diabetes and the unique Japanese national health insurance system that guarantees fair healthcare delivery, there is room to increase the number of LSGs in Japan in the near future. However, strict health insurance regulations may limit access to mandatory devices needed to treat postoperative complications, such as staple line leakage, which can cause severe morbidity and even mortality. Therefore, understanding the pathogenesis and treatment options for this complication is crucial. This article examined the current situation in Japan and its impact on staple line leakage management, including the role of endoscopic treatment in reducing reoperation. The authors suggest increasing education and collaboration between healthcare professionals to optimize management and improve patient outcomes.

Keywords: clip treatment; endoscopic balloon dilation; endoscopic vacuum therapy; laparoscopic sleeve gastrectomy; obesity; percutaneous transesophageal gastro-tubing; revisional surgery; sleeve leakage; stent treatment.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(a) Kangaroo™ W-ED Tube (Cardinal Health, Tokyo, Japan). (b) Schema for the dual use of drainage and nutrition through a single tube.
Figure 2
Figure 2
Over-The-Scope Clip (OTSC®) (Ovesco, Tuebingen, Germany). Clipping is performed after aspirating the fistula opening in the applicator cap, as in endoscopic varicocele ligation. An anchor or twin grasper can be used as an adjunctive tool to ensure lesion capture.
Figure 7
Figure 7
(a) The Roux limb is patched largely around the fistula orifice. (b) Schematic illustration of proximal gastrectomy with double tract reconstruction. The term ‘double tract’ refers to the bi-directional flow of food through the remnant stomach and jejunum after reconstruction, which involves three anastomoses: esophagojejunostomy, gastrojejunostomy, and jejunojejunostomy.
Figure 3
Figure 3
(a) Rigiflex™ II Single-Use Achalasia Balloon Dilators. (b) Achalasia Pneumatic Hand Pump and Monitor. (Boston Scientific, Marlborough, MA, USA).
Figure 4
Figure 4
HANAROSTENT® (M.I. Tech., Pyeongtaek-si, Republic of Korea). The stent consists of a membrane, gold radiopaque markers, and a retrievable lasso attached to its proximal end.
Figure 5
Figure 5
(a) PTEG kit (SB-KAWASUMI LABORATORIES, INC., Akita, Japan). (b) The rupture-free balloon is not ruptured by needle puncture. (c) Image of the double percutaneous transesophageal gastro-tubing.
Figure 6
Figure 6
Endo-SPONGE® kit including open-pore sponge drain, two silicon overtubes, the sponge pusher, and the irrigation set (B. Braun, Meslungen, Germany).
See this image and copyright information in PMC

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