الفهرس 
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Abstract
O
besity is a pandemic health problem in both developed and developing countries and the costs of care continue to grow in parallel with the prevalence of the disease. This morbid condition leads to a high incidence of complications and a decrease in life expectancy, especially among young adults.
Surgical treatment of morbid obesity results in significant sustained weight loss, which reduces obesity-related morbidity and increases survival compared with patients receiving optimal medical therapy.
Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric surgery in the world mainly due to favorable weight loss, comorbidity resolution, and a relatively simple technique. Complications after LSG include leaks, bleeding, and strictures. A multidisciplinary approach is essential to avoid severe long-term morbidity.
These leaks can be responsible for local or general severe septic complications and death. Their management gradually became mainly endoscopic, and the initially described treatment was represented by stents. Despite the first encouraging results, stent deployment showed several major limitations. The original stents were not made for bariatric use, and the risk of migration was extremely high, up to 58% of cases. A new generation of longer endoscopic stents specifically designed represented a new starting point in the endoscopic management of leaks after LSG with a better quality of life for the patient
In this study, we aimed to prospectively evaluate endoscopic therapeutic strategies for leak after sleeve gastrectomy, and evaluate the efficacy of each line of them in different cases.
This prospective study was conducted at tertiary care hospital at Ain Shams University hospitals from January 2018 till January 2022 and performed on total of 30 patients that referred by surgeons from various medical centres, diagnosed with sleeve leakage and were managed using endoscopic stenting, using the covered self-expandable metallic stents, or using the OTSC system and followed up to 4 months postoperatively.
The current study results revealed that gastro-esophageal junction was the most common site of leak with size range from 0.2 to 1.3 cm (mean 0.3 cm). The endoscopic management was done using the covered self-expandable metallic stents in 50% of cases and using the OTSC system in other 50% of cases with success rate of leak closure occurred in 80% of cases and the other 20% of cases were converted to gastric bypass.
The current study revealed that there was no statistically relation between outcome of endoscope management and demographic data of age, sex and BMI with p-value = 0.443, 0.576 and 0.863 respectively.
The study results revealed that 83.3% of patients that converted to gastric bypass had chronic diseases of DM (66.7%), Hypertension (50%) that were not statistically significant compared to the patients with successful leak closure.
The current study results revealed that there were no statistically significant differences among both groups as regards interval between surgery and leak diagnosis, site, size of leak, interval between leak diagnosis and endoscopic management and the method of endoscopic management (p value= 0.320, 0.536, 0.647, 1.000, 0.361) respectively.
We concluded that although the percentage of anastomotic leaks due to laparoscopic sleeve gastrectomy is low, these complications are problematic and can endanger the life of the patient. Great care and a meticulous approach are crucial when performing this intervention in order to prevent their appearance.
The use of endoscopic stent for management of gastric leak after sleeve gastrectomy could be a valid, curative, and safe mini-invasive approach to manage post–sleeve gastrectomy leak, with a low rate of complications and good tolerance by patients and should be in the armamentarium of the surgeon performing bariatric surgery.
We recommend using of endoscopic stent in case of management of leaks after sleeve gastrectomy.