Treatment of Persistent Large Gastrocutaneous Fistulas After Bariatric Surgery: Preliminary Experience with Endoscopic Kehr’s T-Tube Placement

Purpose Post-bariatric surgery gastrocutaneous fistula is a chronic leak with an incidence of 1.7 to 4.0% and no standardized management. A large gastrocutaneous fistula (LGCF) is not indicated for treatment with pigtail drains. We aimed to evaluate results of a novel treatment using endoscopic Kehr...

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Veröffentlicht in:Obesity surgery 2022-04, Vol.32 (4), p.1377-1384
Hauptverfasser: Liagre, Arnaud, Queralto, Michel, Levy, Jonathan, Combis, Jean Marc, Peireira, Paulo, Buchwald, Jane N., Juglard, Gildas, Petrucciani, Niccolò, Martini, Francesco
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container_end_page 1384
container_issue 4
container_start_page 1377
container_title Obesity surgery
container_volume 32
creator Liagre, Arnaud
Queralto, Michel
Levy, Jonathan
Combis, Jean Marc
Peireira, Paulo
Buchwald, Jane N.
Juglard, Gildas
Petrucciani, Niccolò
Martini, Francesco
description Purpose Post-bariatric surgery gastrocutaneous fistula is a chronic leak with an incidence of 1.7 to 4.0% and no standardized management. A large gastrocutaneous fistula (LGCF) is not indicated for treatment with pigtail drains. We aimed to evaluate results of a novel treatment using endoscopic Kehr’s T-tube placement. Methods Only patients with a postoperative LGCF duration of > 10 days and a flow rate of > 50 cc by external drainage after revisional surgery for sepsis were included. Endoscopic placement of Kehr’s T-tube was performed. Patients had been reoperated with wash and drainage for severe sepsis after initial bariatric surgery in which no fistula had been discovered. Patients not reoperated, or with a fistula requiring intraoperative Kehr’s T-tube placement, or a pigtail drain were excluded. Primary outcomes were endoscopic characteristics and results (LGCF closure rate, Kehr T-tube retention time, etc.). Results The study group included 12 women, 2 men; body mass index 43.1 ± 4.5 kg/m 2 . Interventions were SG (7), RYGB (2), OAGB (4), and SADI-S (1). Endoscopic assessment was carried out after a mean of 33.2 ± 44.3 days after the bariatric procedure. The mean fistula orifice diameter was 2.0 ± 0.9 cm. Kehr’s T-tube was positioned at a mean 51.5 ± 54.8 days after the bariatric procedure. T-tube tolerance was excellent. Mean additional days: hospitalization, 34.4 ± 27.0; T-tube retention, 86.4 ± 73.1; fistula healing, 139.9 ± 111.5, LGCF closure rate, 92.9%. Complications: 1 pulmonary embolism, 2 T-tube migrations,1 drain-path bleed, 1 skin abscess. No mortality. Conclusions Endoscopic Kehr’s T-tube placement was successful in closing persistent post-bariatric surgery LGCF in 92.9% of patients. Graphical abstract
doi_str_mv 10.1007/s11695-022-05935-y
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A large gastrocutaneous fistula (LGCF) is not indicated for treatment with pigtail drains. We aimed to evaluate results of a novel treatment using endoscopic Kehr’s T-tube placement. Methods Only patients with a postoperative LGCF duration of &gt; 10 days and a flow rate of &gt; 50 cc by external drainage after revisional surgery for sepsis were included. Endoscopic placement of Kehr’s T-tube was performed. Patients had been reoperated with wash and drainage for severe sepsis after initial bariatric surgery in which no fistula had been discovered. Patients not reoperated, or with a fistula requiring intraoperative Kehr’s T-tube placement, or a pigtail drain were excluded. Primary outcomes were endoscopic characteristics and results (LGCF closure rate, Kehr T-tube retention time, etc.). Results The study group included 12 women, 2 men; body mass index 43.1 ± 4.5 kg/m 2 . Interventions were SG (7), RYGB (2), OAGB (4), and SADI-S (1). Endoscopic assessment was carried out after a mean of 33.2 ± 44.3 days after the bariatric procedure. The mean fistula orifice diameter was 2.0 ± 0.9 cm. Kehr’s T-tube was positioned at a mean 51.5 ± 54.8 days after the bariatric procedure. T-tube tolerance was excellent. Mean additional days: hospitalization, 34.4 ± 27.0; T-tube retention, 86.4 ± 73.1; fistula healing, 139.9 ± 111.5, LGCF closure rate, 92.9%. Complications: 1 pulmonary embolism, 2 T-tube migrations,1 drain-path bleed, 1 skin abscess. No mortality. Conclusions Endoscopic Kehr’s T-tube placement was successful in closing persistent post-bariatric surgery LGCF in 92.9% of patients. Graphical abstract</description><identifier>ISSN: 0960-8923</identifier><identifier>EISSN: 1708-0428</identifier><identifier>DOI: 10.1007/s11695-022-05935-y</identifier><identifier>PMID: 35141869</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Bariatric Surgery - adverse effects ; Drainage - methods ; Endoscopy ; Endoscopy - adverse effects ; Female ; Fistula ; Gastric Fistula - etiology ; Gastric Fistula - surgery ; Gastrointestinal surgery ; Humans ; Male ; Medicine ; Medicine &amp; Public Health ; New Concept ; Obesity, Morbid - surgery ; Sepsis ; Surgery</subject><ispartof>Obesity surgery, 2022-04, Vol.32 (4), p.1377-1384</ispartof><rights>The Author(s) 2022</rights><rights>2022. The Author(s).</rights><rights>The Author(s) 2022. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-89a327cee464b947e9dfd60e329444c813ac94a389c8301aa8fb8aff05a355103</citedby><cites>FETCH-LOGICAL-c474t-89a327cee464b947e9dfd60e329444c813ac94a389c8301aa8fb8aff05a355103</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11695-022-05935-y$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11695-022-05935-y$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35141869$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Liagre, Arnaud</creatorcontrib><creatorcontrib>Queralto, Michel</creatorcontrib><creatorcontrib>Levy, Jonathan</creatorcontrib><creatorcontrib>Combis, Jean Marc</creatorcontrib><creatorcontrib>Peireira, Paulo</creatorcontrib><creatorcontrib>Buchwald, Jane N.</creatorcontrib><creatorcontrib>Juglard, Gildas</creatorcontrib><creatorcontrib>Petrucciani, Niccolò</creatorcontrib><creatorcontrib>Martini, Francesco</creatorcontrib><title>Treatment of Persistent Large Gastrocutaneous Fistulas After Bariatric Surgery: Preliminary Experience with Endoscopic Kehr’s T-Tube Placement</title><title>Obesity surgery</title><addtitle>OBES SURG</addtitle><addtitle>Obes Surg</addtitle><description>Purpose Post-bariatric surgery gastrocutaneous fistula is a chronic leak with an incidence of 1.7 to 4.0% and no standardized management. A large gastrocutaneous fistula (LGCF) is not indicated for treatment with pigtail drains. We aimed to evaluate results of a novel treatment using endoscopic Kehr’s T-tube placement. Methods Only patients with a postoperative LGCF duration of &gt; 10 days and a flow rate of &gt; 50 cc by external drainage after revisional surgery for sepsis were included. Endoscopic placement of Kehr’s T-tube was performed. Patients had been reoperated with wash and drainage for severe sepsis after initial bariatric surgery in which no fistula had been discovered. Patients not reoperated, or with a fistula requiring intraoperative Kehr’s T-tube placement, or a pigtail drain were excluded. Primary outcomes were endoscopic characteristics and results (LGCF closure rate, Kehr T-tube retention time, etc.). Results The study group included 12 women, 2 men; body mass index 43.1 ± 4.5 kg/m 2 . Interventions were SG (7), RYGB (2), OAGB (4), and SADI-S (1). Endoscopic assessment was carried out after a mean of 33.2 ± 44.3 days after the bariatric procedure. The mean fistula orifice diameter was 2.0 ± 0.9 cm. Kehr’s T-tube was positioned at a mean 51.5 ± 54.8 days after the bariatric procedure. T-tube tolerance was excellent. Mean additional days: hospitalization, 34.4 ± 27.0; T-tube retention, 86.4 ± 73.1; fistula healing, 139.9 ± 111.5, LGCF closure rate, 92.9%. Complications: 1 pulmonary embolism, 2 T-tube migrations,1 drain-path bleed, 1 skin abscess. No mortality. Conclusions Endoscopic Kehr’s T-tube placement was successful in closing persistent post-bariatric surgery LGCF in 92.9% of patients. 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A large gastrocutaneous fistula (LGCF) is not indicated for treatment with pigtail drains. We aimed to evaluate results of a novel treatment using endoscopic Kehr’s T-tube placement. Methods Only patients with a postoperative LGCF duration of &gt; 10 days and a flow rate of &gt; 50 cc by external drainage after revisional surgery for sepsis were included. Endoscopic placement of Kehr’s T-tube was performed. Patients had been reoperated with wash and drainage for severe sepsis after initial bariatric surgery in which no fistula had been discovered. Patients not reoperated, or with a fistula requiring intraoperative Kehr’s T-tube placement, or a pigtail drain were excluded. Primary outcomes were endoscopic characteristics and results (LGCF closure rate, Kehr T-tube retention time, etc.). Results The study group included 12 women, 2 men; body mass index 43.1 ± 4.5 kg/m 2 . Interventions were SG (7), RYGB (2), OAGB (4), and SADI-S (1). Endoscopic assessment was carried out after a mean of 33.2 ± 44.3 days after the bariatric procedure. The mean fistula orifice diameter was 2.0 ± 0.9 cm. Kehr’s T-tube was positioned at a mean 51.5 ± 54.8 days after the bariatric procedure. T-tube tolerance was excellent. Mean additional days: hospitalization, 34.4 ± 27.0; T-tube retention, 86.4 ± 73.1; fistula healing, 139.9 ± 111.5, LGCF closure rate, 92.9%. Complications: 1 pulmonary embolism, 2 T-tube migrations,1 drain-path bleed, 1 skin abscess. No mortality. Conclusions Endoscopic Kehr’s T-tube placement was successful in closing persistent post-bariatric surgery LGCF in 92.9% of patients. Graphical abstract</abstract><cop>New York</cop><pub>Springer US</pub><pmid>35141869</pmid><doi>10.1007/s11695-022-05935-y</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record>
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subjects Bariatric Surgery - adverse effects
Drainage - methods
Endoscopy
Endoscopy - adverse effects
Female
Fistula
Gastric Fistula - etiology
Gastric Fistula - surgery
Gastrointestinal surgery
Humans
Male
Medicine
Medicine & Public Health
New Concept
Obesity, Morbid - surgery
Sepsis
Surgery
title Treatment of Persistent Large Gastrocutaneous Fistulas After Bariatric Surgery: Preliminary Experience with Endoscopic Kehr’s T-Tube Placement
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