Endoscopic treatment with biological fibrin glue for gastric fistulas after vertical sleeve gastrectomy

Abstract

Objective: the gastric leak in Laparoscopic Sleeve Gastrectomy involves a therapeutic challenge for succesfull results with less morbility.
Objetive: to describe the endoscopic application of fibrin sealant in the treatment of leaks after sleeve gastrectomy.
Setting: Dr. Julio Méndez´s Hospital, Buenos Aires.
Design: retrospective observational study.
Material and method: in a four-year period, were evaluated the patients operated for morbid obesity and who presented leaks line gastric suture, secondary to vertical gastrectomy treated with biological adhesive application by endoscopy.
Results: 6 patients presented gastric leaks (2,3%). 4 of them fibrin glue is applied endoscopically. All fistulas were low-output and proximal. Three were belated and one early (5th day). The number of sessions necessary was between 1 and 2. In 2 patients was supplemented with application of transcatheter biological adhesive. Closure was achieved in 100% of cases, in a average time of 6.25 days. Oral feeding was started at 7.25 days average. No evidenced complications related to the procedure, nor mortality. The hospital discharge was 11.5 days and the follow-up was 17.25 months with no evidence of recurrence or complications.
Conclusions: we believe that endoscopic treatment with fibrin biological adhesives is successful, with 100% effectiveness in the closure and a clear benefit because of its low morbidity.