STENT FOR REPAIR OF ANASTOMASIS SURGERY LEAKS

Abstract

A stent for repairing post-anastomasis (e.g., bariatric) surgery leaks is formed by an elongated tube having a proximal flare-shaped flange, an enlarged middle section, and a distal flare-shaped flange, where an exterior surface of the elongated tube is substantially covered with a polymer.

Claims

1. A method of repairing a post-anastomosis surgery leak, comprising: positioning a stent in a gastrointestinal tract of a patient with the stent having a proximal end segment in an esophagus of the patient and a distal end segment in a jejunum of the patient; and expanding a middle segment of the stent in a gastric pouch of the patient, the gastric pouch being formed consequent a bariatric surgery on the patient.

2. The method of claim 1, wherein the middle segment expands to substantially fill the gastric pouch.

3. The method of claim 1, further comprising: expanding the proximal end segment to an expanded diameter in the esophagus; and expanding the distal end segment to an expanded diameter in the jejunum.

4. The method of claim 3, wherein the middle segment has an expanded diameter greater than the expanded diameter of the proximal end segment and the expanded diameter of the distal end segment.

5. The method of claim 3, wherein the proximal end segment has a flared flange expanded against a wall of the esophagus.

6. The method of claim 5, wherein the flared flange of the proximal end segment includes a proximal cylindrical portion and a distal truncated cone portion.

7. The method of claim 3, wherein the distal end segment has a flared flange expanded against a wall of the jejunum.

8. The method of claim 7, wherein the flared flange of the distal end segment includes a proximal truncated cone portion and a distal cylindrical portion.

9. The method of claim 1, wherein the middle segment is spherically shaped.

10. The method of claim 1, wherein the stent includes an elongated tube formed of one or more interwoven filaments.

11. The method of claim 10, wherein the stent includes a polymer cover extending along an entire exterior surface of the elongated tube, wherein the polymer cover is configured to seal leaks and prevent tissue in-growth into the elongated tube.

12. The method of claim 11, wherein the polymer cover comprises or is coated with a material that swells in situ.

13. The method of claim 1, further comprising a valve configured to prevent reflux through the stent.

14. A method of repairing a post-anastomosis surgery leak, comprising: positioning a stent in a gastrointestinal tract of a patient with the stent having a flared proximal end segment in an esophagus of the patient and a flared distal end segment in a jejunum of the patient; expanding the flared proximal end segment in the esophagus to an expanded diameter; expanding the flared distal end segment in the jejunum to an expanded diameter; and expanding a middle segment of the stent to an expanded diameter in a gastric pouch of the patient, the gastric pouch being formed consequent a bariatric surgery on the patient.

15. The method of claim 14, wherein the expanded diameter of the middle segment is greater than the expanded diameter of the proximal end segment and the expanded diameter of the distal end segment.

16. The method of claim 14, wherein the stent includes a distal cylindrical segment extending between the flared distal end segment and the middle segment, wherein the distal cylindrical segment has an expanded diameter less than the expanded diameter of the flared distal end segment and the expanded diameter of the middle segment.

17. The method of claim 14, wherein the stent includes a proximal cylindrical segment extending between the flared proximal end segment and the middle segment, wherein the proximal cylindrical segment has an expanded diameter less than the expanded diameter of the flared proximal end segment and the expanded diameter of the middle segment.

18. The method of claim 14, wherein the middle segment expands to substantially fill the gastric pouch.

19. The method of claim 18, wherein the middle segment is spherically shaped.

20. The method of claim 14, further comprising a valve configured to prevent reflux through the stent.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0014] Referring now to the drawings, in which like reference numbers represent corresponding parts throughout:

[0015] FIG. 1 is a schematic view of portions of an alimentary canal after a Roux-en-Y procedure.

[0016] FIG. 2 is a schematic view of portions of an alimentary canal after a biliopancreatic diversion with duodenal switch procedure.

[0017] FIG. 3 is a longitudinal cross-section view of a stent constructed according to one embodiment of the disclosed inventions.

[0018] FIG. 4 is a longitudinal cross-section view of a stent constructed according to another embodiment of the disclosed inventions.

[0019] FIG. 5 is a longitudinal cross-section view of a stent constructed according to yet another embodiment of the disclosed inventions.

[0020] FIGS. 6a and 6b are respective deflated and inflated longitudinal cross-section views of a mandrel according to one embodiment of the disclosed inventions.

[0021] FIG. 7 is a perspective view of a mandrel according to yet another embodiment of the disclosed inventions.

[0022] FIGS. 8a and 8b are respective assembled and disassembled perspective views of a mandrel according to yet another embodiment.

[0023] FIGS. 9a, 9b and 9c are respective perspective views of a mandrel according to still another embodiment of the disclosed inventions. In FIGS. 9a and 9b, the mandrel is fully extended. In FIG. 9c, the mandrel is shortened.

[0024] FIG. 10 is a flow chart of a process for covering a stent, according to still another embodiment of the disclosed inventions.

[0025] FIG. 11 is a flow chart of a method of repairing post-anastomasis surgery leaks using a shape memory polymer stent according to still another embodiment of the disclosed inventions.

DETAILED DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS

[0026] The following Detailed Description of the Illustrated Embodiments, and of alternate embodiments not shown, is provided for purposes of explaining the inventive concepts disclosed herein, and not for purposes of limitation of the appended claims. In particular, while the Detailed Description of the Illustrated Embodiments is directed to the repair of post-bariatric surgery leaks, in a broader aspect, the disclosed inventions are not limited to devices and methods of their manufacture and use for treatment of bariatric leaks, but are also applicable to the treatment of leaks resulting from any anastomosis surgery, i.e., between body lumens and/or between body lumens and organs, and in particular between body lumens and/or organs in the GI system. Embodiments of the disclosed inventions may also be useful for treatment following full thickness resection procedures and/or urology procedures such as a radical prostatectomy.

[0027] FIG. 3 illustrates a single stent 10 configured to temporarily seal leaks after a Roux-en-Y bariatric surgery and to be removed after the leaks have healed. The stent 10 is designed to seal the locations where leaks are most likely to occur. The stent 10 is formed of a single elongated tubular member 12 that is substantially covered with a polymer 14 to seal leaks and to prevent tissue in-growth, which would complicate removal after the leaks have healed. The tubular member 12 is shaped to prevent distal or proximal migration. The tubular member 12 has an enlarged middle segment 16 configured to sit in the gastric pouch and prevent distal or proximal migration. The middle segment 16 also prevents stagnation of food or liquid in the stomach by filling the gastric pouch. In one embodiment, the middle segment 16 is an approximate sphere with a diameter of about 39 mm configured to fill a 30 ml gastric pouch. Proximal of the middle segment 16 is a proximal cylindrical segment 18 configured to extend from the distal esophagus into the proximal stomach, bridging the Z line. In one embodiment, the proximal cylindrical segment 18 is about 20 mm in length and about 20 mm in cross-sectional diameter.

[0028] Proximal of the proximal cylindrical segment 18 is a proximal flare-shaped flange 20 configured to expand along the wall of the distal esophagus to prevent any food or liquid from passing between the stent and the enteral wall. In one embodiment, the proximal flange 20 is about 20 mm in length and about 30 mm in cross-sectional diameter at its widest point. Distal of the middle segment 16 is a distal cylindrical segment 22 configured to extend from the distal stomach into the jejunum, bridging the gastro jejunal anastomosis and the Roux limb. In one embodiment, the distal cylindrical segment 22 is about 20 to 70 mm in length and about 12 mm in cross-sectional diameter. Distal of the distal cylindrical segment 22 is a distal flare-shaped flange 24 configured to expand along the wall of the jejunum to prevent any food or liquid from passing between the stent and the enteral wall. In one embodiment, the distal flange 24 is about 20 mm in length and about 22 mm in cross-sectional diameter at its widest point.

[0029] The tubular member 12 can be formed from alloys such as Elgiloy® and Nitinol® or polymers such as polyethylene terephthalate (PET), like a Polyflex™ stent, and may also be made of a radiopaque material. In some embodiments, the tubular member 12 is made of a biodegradable polymer and substantially covered with a biodegradable polymer 14, and is also radiopaque. The tubular member 12 can have a woven structure (i.e., constructed from one or more filaments). In one embodiment, the tubular member 12 is braided with one filament. In other embodiments, the tubular member 12 is braided with several filaments, as is found, for example, in the WallFlex®, WALLSTENT™ and Polyflex™ stents made and distributed by Boston Scientific. In still another embodiment, the tubular member 12 is knitted, such as the Ultraflex™ stents made by Boston Scientific. In yet another embodiment, the tubular member 12 is of a knotted type, such the Precision Colonic™ stents made by Boston Scientific. In still another embodiment, the tubular member 12 is laser cut, such as the EPIC™ stents made by Boston Scientific. Alternatively, the tubular member 12 can be a combination of any of the above-mentioned stent types. In some embodiments, the stent 10 is self-expanding due to the combination of materials from which the stent 10 is made and the techniques used to make the stent. Fibers used to make the tubular member 12 may be cored fibers, e.g., having a Nitinol™ outer shell and a platinum core. Reference is made to the stents disclosed in U.S. Pat. No. 7,101,392 (Heath), and U.S. Pat. No. 6,527,802 (Mayer), the contents of which are fully incorporated herein by reference.

[0030] The exterior surface of the tubular member 12 may be substantially covered with a polymer 14, which may be resistant to degradation. In various embodiments, the polymer can be silicone, styrene isoprene butadiene (SIBS), expanded polytetrafluoroethylene (ePTFE or expanded Teflon®), or polyurethane. Substantially covering the tubular member 12 with polymer 14 improves the stents 10 ability to occlude leaks. In this regard, the polymer 14 may be made of a material that swells and/or coated with an agent that swells in situ. The polymer 14 also reduces tissue in-growth, which facilitates removal after the leaks have healed, e.g., between 2 to 8 weeks after implantation.

[0031] In some embodiments, the stent 10 comprises a valve 11 to prevent reflux. The valve 11 is located in the proximal cylindrical segment 18 or distal cylindrical segment 22 and is configured to allow flow in the distal direction and prevent flow in the proximal direction. In other embodiments, the stent 10 comprises a removal loop 13 to facilitate removing the stent 10 by pulling proximally. In still other embodiments, the stent 10 is coated with a drug configured to improve healing or, more generally, a therapeutic agent. In yet other embodiments, the stent 10 includes radiopaque markers 15 for fluoroscopic positioning.

[0032] The stent 10 in FIG. 4 is configured to temporarily seal leaks at the gastro jejunal anastomosis after a Roux-en-Y bariatric surgery and to be removed after the leaks have healed. The distal cylindrical segment 22 and the distal flair-shaped flange 24 are identical to the corresponding parts in the stent 10 in FIG. 3. Proximal of the distal cylindrical segment 22 is a gastric flange 26, configured to sit in the distal gastric pouch and prevent any food or liquid from passing between the stent and the enteral wall. The gastric flange 26 also cooperates with the distal flange 24 to prevent distal or proximal migration of the stent 10. In one embodiment, the gastric flange 26 is a bowl with a length of about 20-30 mm and a diameter of about 40 mm at its widest point. This stent 10 is similar to distal half of the stent 10 in FIG. 3. In alternative embodiments, the flange 26 may take any open shape, such as, e.g., a bowl, a truncated cone, a saucer, etc.

[0033] The stent 10 in FIG. 5 is configured to temporarily seal leaks after a sleeve gastrectomy or a biliopancreatic diversion with duodenal switch, and to be removed after the leaks have healed. After these procedures, the stomach pouch is long and thin, as shown in FIG. 2. Accordingly, stents 10 used for sealing leaks after these procedures have a longer segment in the stomach. Such stents 10 are designed to seal the locations where leaks are most likely to occur after these procedures (i.e., Z line, stomach staple line, duodeno-jejunal anastomosis). The stent 10 may comprise an elongated tubular member 12 that is substantially covered with a polymer 14 as described above. The tubular member 12 is shaped to prevent distal or proximal migration.

[0034] The tubular member 12 has an enlarged middle segment 16 configured to sit in the stomach antrum and prevent distal or proximal migration. In one embodiment, the middle segment 16 has an ovoid shape with a length of about 60 mm and a cross-sectional diameter of about 50 mm at its widest point. The middle segment 16 is configured to sit in the antrum of the stomach and cooperates with the proximal and distal flanges 20, 24 to prevent distal or proximal migration of the stent 10.

[0035] Proximal of the middle segment 16 is a proximal cylindrical segment 18 configured to extend from the distal esophagus into the proximal stomach, bridging the Z line. In one embodiment, the proximal cylindrical segment 18 is about 260 mm in length and about 15 mm in cross-sectional diameter. Proximal of the proximal cylindrical segment 18 is a proximal flare-shaped flange 20 configured to expand along the wall of the distal esophagus to prevent any food or liquid from passing between the stent and the enteral wall. In one embodiment, the proximal flange 20 is about 20 mm in length and about 30 mm in cross-sectional diameter at its widest point. Distal of the middle segment 16 is a distal cylindrical segment 22 configured to extend from the distal stomach, through the duodenum and into the jejunum, bridging the duodeno-jejunal anastomosis. In one embodiment, the distal cylindrical segment 22 is about 50 mm in length and about 20 mm in cross-sectional diameter. Distal of the distal cylindrical segment 22 is a distal flare-shaped flange 24 configured to expand along the wall of the jejunum to prevent any food or liquid from passing between the stent and the enteral wall. In one embodiment, the distal flange 24 is about 20 mm in length and about 30 mm in cross-sectional diameter at its widest point. The same stent shape can also be used to treat leaks after sleeve gastrectomy.

[0036] The dimensions of the above-described embodiments are provided for illustration and not limitation. One of skill in the art will recognize that the dimensions of the stent 10 can be modified to fit various anatomies. Because some embodiments of the stent 10 include an enlarged middle segment 16, various mandrels 30 have been designed to facilitate removal of the mandrel 30 after forming the stent 10 around the mandrel 30. The mandrel 30 in FIGS. 6a and 6b has an inflatable component 32 in the middle of the mandrel 30. Either during or after forming the stent 10 around the mandrel 30, the inflatable component 32 is inflated to form the enlarged middle segment 16 of the stent 10. After the stent 10 is formed, e.g., braided and heat-treated, the inflatable component 32 is deflated and the mandrel 30 is removed from the stent 10 by disconnecting one of the enlarged flange forming end pieces from the mandrel 30.

[0037] The mandrel 30 in FIG. 7 has wire elements 34 releasably attached to the middle of the mandrel 30 and configured to form the enlarged middle segment 16 of the stent 10. After the stent 10 is formed around the mandrel 30, the wire elements 34 are released from the mandrel 30 and removed from the stent 10 along with the rest of the mandrel 30. The mandrel 30 in FIGS. 8a and 8b has a core 36 and two end pieces 38. In some embodiments, the elements 34 are flat strips. When the mandrel 30 is assembled (FIG. 8a), the core 36 is configured to form the enlarged middle segment 16 of the stent 10. For example, the elements may be configured to bow outwardly by axial movement of the mandrel towards the other end.

[0038] After the stent 10 is formed around the mandrel 30, the core 36 is disassembled as in FIG. 8b and removed from the stent 10 along with the end pieces 38. As shown in FIG. 8b, the core 36 may include six slices 40 that each has a projection 42 with two polar notches 44. Each of the end pieces 38 has a recess 46 into which one polar notch 44 from each slice 40 sits when the mandrel 30 is assembled to hold the core 36 together. Accordingly, the core 36 can be dissembled by pulling the end pieces 38 apart from each other. In some embodiments, the slices 40 are cored out or hollowed to facilitate their removal from the stent 10. It will be appreciated that fewer or more end pieces 38 and/or slices 40 may be employed in alternate embodiments.

[0039] The mandrel 30 in FIGS. 9a, 9b, and 9c is made of a first coaxial section 48 that is slidably disposed in a second coaxial section 50. First the coaxial sections 48, 50 are pulled apart from each other, as shown in FIG. 9a, such that the mandrel 30 is at its maximum length. Then the stent 10 is formed (but not set) around the elongated mandrel 30 and attached to the mandrel 30 at bonding points 54, as shown in FIG. 9b. Next the coaxial section 48, 50 are pushed toward 58 each other, as shown in FIG. 9c. This motion 58 along with the attachment of the stent 10 to the mandrel 30 causes the middle of the mandrel 30 to displace radially and form the enlarged middle segment 16 of the stent 10. Then the stent 10 is set and the mandrel 30 is removed from the stent 10. In other embodiments, the mandrel 30 is removed from the stent 10 by destroying the mandrel 30.

[0040] After the stent 10 is formed and the mandrel 30 is removed, the stent 10 can be substantially covered with polymer 14 through various methods (e.g., dipping, spraying, sandwiching, heat shrinking or electro-spinning) In the embodiment shown in FIG. 10, the stent 10 is inserted 62 into an interior of a mold configured to mimic the exterior shape of the stent 10. Then a covering solution is added 64 to the interior of the mold. Next, mold is rotated and tilted 66 about its center axis to cover the stent 10 with the covering solution. Finally, the covered stent 10 is removed 68 from the mold. Heat can be added to the process for solvent evaporation and/or curing. The formed and covered stent 10 can be implanted during an endoscopic procedure. During the procedure, the stent 10 is mounted on a delivery device for delivery under direction vision or under fluoroscopy. In the embodiment shown in FIG. 11, a stent 10 made from a shape memory polymer is delivered over an inflatable balloon or a mechanically expandable basket that is expanded in-situ to impart the desired shape to the stent 10.

[0041] Shape memory polymers generally have both hard and soft molecular structures, which are relative terms relating to the transition temperature of the segments. These “segments” are blocks or sequences of polymer forming part of the shape memory polymer. Typically, hard segments have a higher glass transition temperature (Tg) than soft segments. Shape memory polymers include a class of (meth)acrylate compositions having a first (meth)acrylate monomer with a lower glass transition temperature (Tg typically less than 25.degree. C.) and a second (meth)acrylate monomer with a higher glass transition temperature (Tg typically greater than 25.degree. C.).

[0042] Shape memory polymers, e.g., thermoplastic and thermoset (covalently cross-linked) polymeric materials, used for forming stents 10 may include elastomers that are typically crosslinked and/or crystalline and exhibit melt or glass transitions at temperatures that are above body temperature and safe for use in the body (e.g., at about 40.degree. C. to about 50.degree. C.). Such shape memory polymers include those that maintain stent geometry under expansion conditions without fracture or substantial irreversible stress relaxation or creep. Typically, the stent 10 may be heated to or above the melt or glass transition temperature of the shape memory polymer during expansion. In these temperatures, the polymer may be in a softened state. After the stent 10 is fully expanded and cooled, the shape memory polymer substantially sets in the desired shape and location (e.g., adjacent a leak site). The polymer can have some elastomeric properties in the cooled, hardened state so that the stent 10 can flex with natural body motion. After cooling, the stent 10 exhibits sufficient resistance to inward radial force to keep a body lumen open. After the leaks have healed, the stent 10 may be softened by heating for removal.

[0043] Referring to FIG. 11, a leak is repaired by first mounting 70 a shape memory polymer stent 10 on an expandable device, such as (without limitation) an inflatable balloon or a mechanically expandable basket. The expandable device and stent 10 are then inserted 72 into the alimentary canal proximate a leak. Next, the expandable device is then expanded, thereby expanding the stent 10 against the leak. In the embodiment of FIG. 11, the expandable device is a balloon that is expanded 74 by application of pressure, and heat is added to thereby soften the stent to allow for its in-situ expansion. The application of added heat is stopped, and the stent 10 is allowed to cool and set 76, while the expanded size of the balloon is maintained in order to form the desired shape of the stent 10. Next, the balloon is deflated 78 by removing the application of pressure, and the balloon is removed 80 from the stent through the alimentary canal. After the leaks have healed 82, the stent may (optionally) be removed by softening the stent with the application of heat 84.

[0044] While various embodiments of the disclosed inventions have been shown and described, it should be appreciated that they are presented for purposes of illustration, and not limitation. It will be appreciated that various modifications may be made to the illustrated and described embodiments without departing from the scope of the disclosed inventions, which is to be defined only by the following claims and their equivalents.