Severe Events Related to Use of Stents in Bariatric Surgical Complications
Angelo Iossa, MD, Fausto Fiocca, MD, Mario Corona, MD, Giuseppe Cavallaro, MD, PhD, Fabrizio Cereatti, MD, Mario Rizzello, MD, PhD, Gianfranco Silecchia, MD, PhD
Department of Medical Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Center of Excellence “ICOT,” Sapienza University of Rome, Rome, Italy (Drs. Iossa, Cavallaro, Cereatti, Rizzello, Silecchia). Department of Surgical Sciences and Organ Transplantation—P. Stefanini, Sapienza University of Rome, Rome, Italy (Dr. Fiocca). Vascular and Interventional Unit, Department of Radiological Sciences, Sapienza University of Rome, Rome, Italy (Dr. Corona).
Introduction: Endoscopic self-expandable stents are emerging as safe and effective options for the treatment of bariatric surgery complications. Our aim is to report 3 cases of severe complications after self-expandable stent implantation.
Case Description: A retrospective database analysis showed 14 major complications over the past 400 bariatric procedures (3.5%); 8 of them were managed conservatively. Three cases of unusual severe complications after self-expandable stent implantation were observed. In case 1 (leak after resleeving), the self-expandable stent migrated twice and caused an esophageal stenosis, which was treated by endoscopic dilation. Three months later, the stenosis recurred and the patient was a candidate for distal esophagectomy. In case 2 (gastrojejunal stricture after Roux-en-Y gastric bypass), the endoscopic dilation was complicated by perforation and treated with a self-expandable stent. The patient required an emergency laparoscopy to remove the stent that had migrated into the ileum. After 1 month, gastrojejunal stenosis recurred and the patient underwent laparoscopic revision of the anastomosis. In case 3 (leak after vertical banded gastroplasty [VBG]–Roux-en-Y gastric bypass conversion), the self-expandable stent migrated twice and caused an esophageal-pleural fistula managed with a new stent.
Discussion: Bariatric surgeons have to balance the possible advantages of self-expandable stents on a case-by-case basis. Complications of endoscopic stents can be life-threatening and are underestimated and under-reported in the literature.
Key Words: Bariatric surgery complications, Endoscopic management, Stent complication.