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2016 ; 10
(ä): 3
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Novel treatments for complications after bariatric surgery
#MMPMID26981148
Hernández J
; Boza C
Ann Surg Innov Res
2016[]; 10
(ä): 3
PMID26981148
show ga
Bariatric surgery has been considered one of best treatments for obesity. As
every surgical procedure-and any medical intervention, it is not exempt of
complications, among which leaks, strictures, acute hemorrhages and fistulae
highlight. Leaks are more common in the gastro-jejunal anastomosis (GJA) in the
case of Roux-en-y Gastric Bypass (RYGB), while in Sleeve Gastrectomy (LSG) they
locate in the stapler line. Stenosis can be seen in the gastro-jejunostomy in the
RYGB and in the gastric tube in case of the LSG. For each of these complications,
many innovative solutions have been developed, including new surgical devices. In
spite of promising good results, evidence regarding utility and safeness of these
technologies is still scarce. Self-expandable endoscopic stents have been used to
treat leaks, with an overall success rate of 80-90 % and a migration rate of
15-35 %. The bear trap-like over-the-scope (Ovesco) clips have been used to treat
GI hemorrhages, leaks and even fistulae, with a 70-80 % success rate, although
more endoscopic sessions may be needed. Overstitch, an endosurgical suture
devices, have been used to treat leaks, fistulae and perforations. Overall,
technical success achievement approaches to 90 %, while clinical success ranges
from 80 to 90 %, except for leaks closure, where a lower success rate has been
observed. Despite of all of these advances, early diagnosis and treatment remains
the main strategy to achieve success. In summary, novel therapies for
complication management can be very useful, though further studies with larger
series are still needed in order to confirm their efficacy and safeness.