IBC Oxford University Oral Abstract 13 - Video abstract: fistula treatment after bariatric surgery with partially covered metallic stent -laparoscopic removal

Abstract Case Presentation The patient underwent Roux in Y Gastric Bypass by laparoscopy without complications, developing on postoperative day 7 with an abscess in the epigastrium at the site of the 5 mm portal, associated with local pain, fever and chills. Within 24 hours, there was spontaneous drainage of large amounts of purulent secretion, with pain improvement. The patient was advised to be hospitalized again and started on broad-spectrum antibiotic therapy. Abdominal CT and Upper GI endoscopy were performed, which revealed leakage from the gastro-enteric anastomosis with spontaneous cutaneous drainage without compromising the cavity. The patient remained with a WallFlexTM Oesophageal 23 mm stent for 34 days, with complete remission of the infectious condition. Endoscopic removal attempts of the stent were unsuccessful due to adherence by pseudo-polyptic adhesions that fixed the uncovered area of the stent extremities, preventing endoscopic detachment and consequent removal. We chose to perform laparoscopic access through the alimentary loop immediately below the gastro-enteric anastomosis was performed with an enterotomy with identification of the stent at its distal end, The stent was released and exteriorised to the proximal portion with laparoscopic section of the pseudo-polyps at the proximal end that fixed the Stent. We were able to free the proximal end by removing the stent without additional injuries via the enterotomy. Enterorrhaphy and cavity drainage were performed. The patient was discharged on postoperative day 3 progressing clinically well and under endoscopic control after 9 months with maintained surgical anatomy and satisfactory surgery results.