Innovative Use of Atrial Septal Defect Occluders for Gastric Leak Management After Sleeve Gastrectomy: A Case Report.

BACKGROUND Atrial septal defect (ASD) occluder devices present a novel approach for managing persistent gastric leaks following sleeve gastrectomy. While sleeve gastrectomy is effective, postoperative leak rates reach up to 3% in primary surgeries and exceed 10% in revisions, with management remaining complex and non-standardized. CASE REPORT This case report describes a 20-year-old Saudi woman who developed a gastric leak after laparoscopic sleeve gastrectomy. After a failed initial treatment with a self-expandable mega stent that migrated, she presented with severe symptoms and a significant sub-capsular splenic collection. Despite ultrasound-guided drainage and endoscopic interventions, leakage persisted. An ASD occluder device was deployed using endoscopic and fluoroscopic guidance following failed repairs. While post-application imaging initially showed no leaks and the patient's condition improved, she later experienced recurrent symptoms with persistent leakage. The case was ultimately resolved through a Roux-en-Y gastric bypass. CONCLUSIONS This case highlights the potential of ASD occluders in treating complex gastric leaks, particularly for patients reluctant to undergo repeated surgeries. The device's flexibility for repositioning and retrieval, combined with endoscopic compatibility, makes it a valuable tool for managing postoperative bariatric complications. While initial results are promising, further research is needed to validate this approach's efficacy and safety. Future studies should focus on larger cohorts to establish guidelines for ASD device use in gastrointestinal applications.