Natural orifice surgery (NOS) using StomaphyX for repair of gastric leaks after bariatric revisions

Abstract

Gastric leaks represent serious complications of bariatric surgery. With the increasing popularity and performance of bariatric procedures, the incidence of leaks and associated complications are expected to increase. Minimally invasive natural orifice surgery represents a novel and promising approach to gastric leak management, especially for morbidly obese patients who are at much higher risk from open or laparoscopic surgical procedures. The present article reports two cases of the safe and successful use of the EndoGastric Solutions StomaphyX device to alter the flow of gastric contents and repair gastric leaks resulting from bariatric revision surgery. Both patients were at a high risk and could not undergo another open or laparoscopic surgery to correct the leaks that were not healing. The StomaphyX procedures lasted approximately 30 min, were performed without any complications, and resulted in the resolution of the gastric leaks in both patients.

Figures

Fig. 1

A general view (a) and the shaft part (b) of the StomaphyX device

Fig. 2

Upper GI radiography showing leak inferior to the jejunum in patient 1

Fig. 3

Upper GI radiography after the StomaphyX procedure showing flow into the jejunum in patient 1

Fig. 4

Upper GI radiography showing a horizontal leak from duodenal switch near gastro-esophageal junction on the greater curvature side of the stomach in patient 2

Fig. 5

Computer tomography scan on the day after the StomaphyX procedure showing no evidence of leak in patient 2