Management of Distal Gastric Leak After Laparoscopic Sleeve Gastrectomy by Double Pigtail Catheter

Abstract

Background: Gastric leaks after laparoscopic sleeve gastrectomy (LSG) is the most feared complication due to the difficulty in its management. Management of these leaks frequently requires use of internal drainage catheters accompanied by self-expandable metal stents (SEMS). Recently, endoscopic internal drainage by double pigtails catheter (DPC) has been recommended after previous studies found it was better tolerated, required fewer procedures, and was associated with a shorter healing time compared to use of SEMs. In this report, we describe our treatment by DPC of a patient who had experienced distal gastric leak after undergoing LSG. Case Report: A 28-year-old female patient who had undergone LSG 40 days ago was referred to our clinic. She had experienced postoperative leaking that had been unsuccessfully managed by conservative treatment. Upper gastrointestinal (GI) examination and computed tomography (CT) scanning showed perigastric distal leak and abscess formation. Endoscopic examination revealed a 5 mm fistula orifice from the starting point of the staple line and the guide delivered across the orifice emerging from the skin from the drain side. After expanding the fistula orifice using endoscopic electrocautery, we placed a DPC. Soft food digestion which was initiated on postoperative day 1 is then followed by normal food digestion on postoperative day 3. The DPC was removed using endoscopic snare after complete closure of the orifice was observed at postoperative week 4. Conclusion(s): Use of DPC in the treatment of distal leaks provides complete drainage of perigastric collections and stimulates mucosal growth over the catheter, making it a safe and effective means of leak management.