Successful Management of Refractory Staple Line Leakage at the Esophagogastric Junction After a Sleeve Gastrectomy Using the HANAROSTENT

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Abstract
The esophagogastric junction (EGJ) is a potential site of leakage after a sleeve gastrectomy which is usually difficult to treat conservatively. Two patients underwent a laparoscopic sleeve gastrectomy. A subphrenic abscess due to a staple line leakage was detected by CT at 3 weeks and 10 days after the operation, respectively. The abscess was drained laparoscopically. Intractable leakage required several endoscopic treatments, including clipping and sealing. However, a persisting fistula was found on radiographic studies. A covered self-expandable and retrievable stent (HANAROSTENT®) was finally placed over the leakage site at 15 and 6 weeks after the reoperation, respectively. Oral intake was achieved from poststent day 1, and they were discharged 2 weeks after stenting. Three months later, the stent was endoscopically removed and the leakage was successfully sealed. The HANAROSTENT is therefore considered to be a safe and effective therapeutic option for the management of staple line leakage at the EGJ.

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