Original article Management of anastomotic leaks after Roux-en-Y bypass using self-expanding polyester stents Christopher A. Edwards, M.D., Phiet T. Bui, M.D., J. Andrés Astudillo, M.D., Roger A. de la Torre, M.D., F.A.C.S., Brent W. Miedema, M.D., F.A.C.S.*, Archana Ramaswamy, M.D., F.A.C.S., Nicole M. Fearing, M.D., F.A.C.S., Bruce J. Ramshaw, M.D., F.A.C.S., Klaus Thaler, M.D., F.A.C.S., J. Stephen Scott, M.D., F.A.C.S. Department of Surgery, University of Missouri–Columbia, Columbia, Missouri Received June 9, 2007; revised February 27, 2008; accepted May 1, 2008 Abstract Background: To analyze the outcomes of a series of endoscopically placed polyester self-expand- ing polyflex stents (SEPSs) for the management of anastomotic leaks after Roux-en-Y bypass. Anastomotic leaks after gastric bypass cause significant morbidity and mortality. Covered polyester SEPSs might have a role in the treatment of these leaks. Methods: A retrospective chart review was performed from January 2006 to November 2006 that included all acute and chronic leaks treated with SEPSs. Results: A total of 6 patients were treated with stents, with a mean procedure time of 22 minutes. Of these 6 patients, 5 had acute postoperative leaks and 1 had a chronic fistula. Five patients started oral intake 1– 6 days after their procedure. All acute leaks had complete healing at a median of 44 days. The patient with a chronic gastrocutaneous fistula required revisional surgery for fistula closure. In addition, 5 patients had stent migration, and 3 required stent replacement. Conclusion: An endoscopically placed SEPS provides a less-invasive alternative to treat acute anastomotic leaks after Roux-en-Y bypass while simultaneously allowing oral intake. The results of this case series have demonstrated this treatment to be safe and effective. (Surg Obes Relat Dis 2008;4:594 – 600.) © 2008 American Society for Metabolic and Bariatric Surgery. All rights reserved. Keywords: Gastric bypass; Anastomotic leak; Endoscopy; Stent The incidence of anastomotic leaks after Roux-en-Y gastric bypass (RYGB) procedures ranges from 0.3% to 8.3% and has been similar in both open and laparoscopic series [1]. Anastomotic leaks at the gastrojejunostomy (GJ) or esophagojejunostomy (EJ) after Roux-en-Y by- pass can be difficult to treat and can result in significant morbidity and mortality. Therefore, it is essential to im- prove the methods of treating anastomotic leaks after RYGB. The conventional management of anastomotic leaks after RYGB has historically been surgical [2]. The tenets of surgery include washout of the peritoneal cavity, appropriate debride- ment and repair of the anastomotic leak, followed by drainage of this region. Drainage modalities range from percutaneous radiographically guided drainage, open surgical drainage, or intraluminal T-tube placement at the leak site. Laparoscopic or open approaches can be performed according to the surgeon’s expertise and the clinical situation. In a subset of hemodynam- ically stable and asymptomatic patients, nonoperative expect- ant management can be used. Within these scenarios, most *Reprint requests: Brent W. Miedema, M.D., F.A.C.S., University of Missouri, One Hospital Drive, MC422 McHaney Hall, DC075.00, Colum- bia, MO 65212. E-mail: MiedemaB@health.missouri.edu Surgery for Obesity and Related Diseases 4 (2008) 594 – 600 1550-7289/08/$ – see front matter © 2008 American Society for Metabolic and Bariatric Surgery. All rights reserved. doi:10.1016/j.soard.2008.05.009