Treatment of Persistent Leaks After Laparoscopic Sleeve Gastrectomy with the Simultaneous Over-the-Scope Clip (OTSC) and Mega Stent Strategy.

Persistent staple-line leak is a challenging complication after laparoscopic sleeve gastrectomy (LSG). The over-the-scope clip (OTSC) (Ovesco®, Tübingen, Germany) and the Mega stent (Taewoong medical, Seoul, South Korea) recently gained encouraging results in the management of early leaks. This is a retrospective series (n = 8) focused on the management of persistent leaks after LSG with the simultaneous OTSC/Mega stent strategy. Seven patients underwent primary LSG. The median time from LSG to OTSC/Mega stent treatment was 48.5 days (range 28-63), and the median defect size was 9.5 mm (range 7-12). The median time to clear liquid diet, hospital length of stay, and overall treatment time were 4 days (range 2-5), 31 days (range 26-57), and 47 days (range 34-107), respectively. Overall success rate was 87.5%. Postoperative morbidity was 25%. The mean follow-up time was 18 months (range 3-24) with no fistula recurrence.

An unusual case of acute fatal pulmonary congestion: oesophageal stenting.

Extrinsic left atrial compression with consequent hemodynamic compromise has been described secondary to aortic aneurysm, huge gastroesophageal distension and neoplastic diseases involving mediastinum. Prompt correction of the primary pathology usually leads to reversal of hemodynamic alterations. We report the case of a lady, who, in order to treat a stenosis of the lower third of the oesophagus, underwent stenting with subsequent hemodynamic deterioration due to compression of the posterior left atrial wall disclosed by echocardiography. The sudden recovery of the oesophageal lumen at the expense of the left atrial volume with the impossibility of prompt removal of the stent led to a progressive and fatal deterioration of the hemodynamic picture. Stenting of the lower part of the oesophagus should be performed only when reciprocal anatomic relationship between heart and oesophagus itself is clearly elucidated and possibly well maintained.