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).

ABSTRACT

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.

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Department of Gynecological Endoscopy and Anatomopathology, Nuova Villa Claudia Hospital, Rome, Italy (Drs. Sizzi, Rossetti, Soda, Pellegrino). Department of Radiological Oncological and Anatomopathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy (Drs. Saldari, Manganaro).

ABSTRACT

Experience with minimally invasive approaches, such as laparoscopic ablation and transanal endoscopic microsurgery, to resection pelvic retroperitoneal and presacral tumors is limited. Masses arising from this anatomic position are usually removed using a transsacral approach or laparotomy. We report a detailed description of the laparoscopic procedure performed in a 32-year-old woman to remove a mass, which was detected with both ultrasonography and magnetic resonance imaging, that was closely adherent to the left sacrospinous ligament and compressing the rectum. Histopathologic findings were consistent with a rare case of pelvic retroperitoneal epidermoid cyst. This tumor, which usually occurs in the face, the scalp, the trunk, or the neck, has been described in the pelvic retroperitoneal space in only a few cases.

Key Words: Epidermoid cyst, Laparoscopy, Magnetic resonance imaging, Retroperitoneal cysts.

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