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Zhang Y, Wang Y, Bian S, Li M, Zhang M, Zhang P, Zhang Z, Liu Y. Treatment of Leakage Following Sleeve Gastrectomy by Laparo-Endoscopic Gastrostomy (LEG). Obes Surg 2024:10.1007/s11695-024-07417-9. [PMID: 39034373 DOI: 10.1007/s11695-024-07417-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 07/16/2024] [Accepted: 07/17/2024] [Indexed: 07/23/2024]
Abstract
Sleeve gastrectomy (SG) is widely recognized as the leading bariatric procedure worldwide. However, leakage, its major complication, remains a significant concern. This study focuses on the challenges of managing leakage, especially when conventional endoscopic treatments are ineffective. Although a novel one-step approach as reported by Pulimuttil James Zachariah from Wei-Jei Lee's team has demonstrated promise, further investigations and reports on its efficacy are currently insufficient. Between January 2021 and November 2023, we analyzed five patients treated at our center for SG leakage. Patient data include demographics, comorbidities, surgical details, and outcomes. The study details Laparo-Endoscopic Gastrostomy procedures performed post-SG leakage diagnosis, highlighting differences between acute and chronic instances. The study effectively implemented Zachariah's one-step approach, achieving favorable results in all five cases. Patient characteristics, presentation, postoperative progression, and additional treatments were documented. The outcome supports Zachariah's assertion that the one-step approach is a simple, safe, and cost-effective approach for SG leakage, avoiding digestive tract reconstruction. Despite potential limitations, including challenges in closing large defects and extended healing times, the procedure's effectiveness in decompression, drainage, and nutritional support significantly contributes to its elevated healing rate. The study emphasizes the importance of timely abdominal drain removal based on clinical conditions, challenging traditional practices for better clinical outcomes.
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Affiliation(s)
- Yiqiao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & State Key Lab of Digestive Health & National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China
| | - Yongqiang Wang
- Department of Gastrointestinal Surgery, Inner Mongolia People's Hospital, No. 20 Zhao Wuda Road, Hohhot, 010020, Inner Mongolia, China
| | - Shibo Bian
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & State Key Lab of Digestive Health & National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China
| | - Mengyi Li
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & State Key Lab of Digestive Health & National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China
| | - Meng Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & State Key Lab of Digestive Health & National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China
| | - Peng Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & State Key Lab of Digestive Health & National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & State Key Lab of Digestive Health & National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China.
| | - Yang Liu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & State Key Lab of Digestive Health & National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China.
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Abu-Abeid A, Litmanovich A, Abu-Abeid S, Eldar SM, Lahat G, Yuval JB. Long-Term Outcomes of Patients with Staple Line Leaks Following Sleeve Gastrectomy. Obes Surg 2024; 34:2523-2529. [PMID: 38814413 PMCID: PMC11217129 DOI: 10.1007/s11695-024-07307-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE The long-term outcomes of patients with staple line leaks (SLL) after SG are under-reported. The purpose of this study is to evaluate the long-term outcomes of patients with SLL after SG. MATERIALS AND METHODS A retrospective analysis of a maintained patient registry of patients undergoing SG between January 2012 and December 2020 in a single bariatric center was analyzed and included patients with SLL. Outcomes were compared to a group without SLL. RESULTS During this period, 1985 patients underwent SG of which 61 patients (3.1%) developed leak. 26 patients (1.3%) had overt SLL and the rest had organ space infection around the staple line. The mean age and body mass index (BMI) were 39.8 ± 11.3 and 41.5 ± 4.7, respectively. 7 patients (11.4%) underwent concomitant surgery and 12 patients (19.7%) had intraoperative complications. Leak was complicated by Clavien-Dindo ≥ 3 in 31 patients (50.8%). Reoperation rate was 27.8% (n = 17). ≥ 2 interventions were required in 26% of patients (n = 16). Two patients died during hospitalization due to septic complications. Long-term follow-up of median 121 months was available in 78% of the cohort (n = 48). The median total weight loss and BMI were 27% and 30.1 kg/m2, respectively. Weight loss outcomes were higher in comparison to patients without SLL. Seven patients (14.6%) underwent SG revision. All associated medical problems improved during follow-up except for gastroesophageal reflux which was found in 50% of cohort. CONCLUSION Long-term outcomes of SG patients with SLL are satisfactory in terms of weight loss, resolution of comorbidities, and requirement for surgical revision.
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Affiliation(s)
- Adam Abu-Abeid
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, 6, Weizman St., 6423906, Tel- Aviv, Israel.
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman St., 6423906, Tel- Aviv, Israel.
- Tel Aviv University, The Faculty of Medical & Health Sciences, Tel- Aviv, Israel.
| | - Adi Litmanovich
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, 6, Weizman St., 6423906, Tel- Aviv, Israel
- Tel Aviv University, The Faculty of Medical & Health Sciences, Tel- Aviv, Israel
| | - Subhi Abu-Abeid
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, 6, Weizman St., 6423906, Tel- Aviv, Israel
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman St., 6423906, Tel- Aviv, Israel
- Tel Aviv University, The Faculty of Medical & Health Sciences, Tel- Aviv, Israel
| | - Shai Meron Eldar
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, 6, Weizman St., 6423906, Tel- Aviv, Israel
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman St., 6423906, Tel- Aviv, Israel
- Tel Aviv University, The Faculty of Medical & Health Sciences, Tel- Aviv, Israel
| | - Guy Lahat
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, 6, Weizman St., 6423906, Tel- Aviv, Israel
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman St., 6423906, Tel- Aviv, Israel
- Tel Aviv University, The Faculty of Medical & Health Sciences, Tel- Aviv, Israel
| | - Jonathan Benjamin Yuval
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, 6, Weizman St., 6423906, Tel- Aviv, Israel
- Tel Aviv University, The Faculty of Medical & Health Sciences, Tel- Aviv, Israel
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Coşkun M, Uprak TK, Günal Ö, Aliyeva A, Cingi A. Reinforcement in Laparoscopic Sleeve Gastrectomy: Is It Effective? Surg Laparosc Endosc Percutan Tech 2024; 34:290-294. [PMID: 38736400 DOI: 10.1097/sle.0000000000001283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 03/08/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Despite the success of bariatric surgery in treating obesity, it can still lead to complications. The most serious and feared technical complications are bleeding and leakage from the gastric staple line. In this study, stapler line reinforcement was investigated to determine whether it affects postoperative leakage and bleeding rates and their management. MATERIALS AND METHODS Overall, 510 patients who underwent sleeve gastrectomy were evaluated retrospectively. They were divided into 2 groups according to whether reinforcement of the staple line with running imbricating sutures was performed. RESULTS In the reinforcement group, there were two leaks (0.7%), which were diagnosed seven and eight days after surgery. In the non-reinforcement group, there were nine leaks (4%). There was no difference between the two groups in staple line bleeding. CONCLUSIONS This study shows that reinforcement with continuous imbricating sutures is associated with less stapler line leakage and a lower reoperation rate at the cost of increased operative time.
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Affiliation(s)
- Mümin Coşkun
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
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Firkins SA, Simons-Linares R. Management of leakage and fistulas after bariatric surgery. Best Pract Res Clin Gastroenterol 2024; 70:101926. [PMID: 39053976 DOI: 10.1016/j.bpg.2024.101926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 06/04/2024] [Indexed: 07/27/2024]
Affiliation(s)
- Stephen A Firkins
- Bariatric and Metabolic Endoscopy, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Roberto Simons-Linares
- Bariatric and Metabolic Endoscopy, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
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Dayma K, David A, Omer A, Abdel-Dayam H, Tawil A, Socci N, Ahmed L, Gilet A, Haddad D. Routine Upper Gastrointestinal Series Post-bariatric Surgery: Predictors, Usage, and Utility. Obes Surg 2024; 34:1552-1560. [PMID: 38564172 DOI: 10.1007/s11695-024-07125-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To investigate usage and utility of routine upper gastrointestinal (UGI) series in the immediate post-operative period to evaluate for leak and other complications. METHODS Single institution IRB-approved retrospective review of patients who underwent bariatric procedure between 01/08 and 12/12 with at least 6-month follow-up. RESULTS Out of 135 patients (23%) who underwent routine UGI imaging, 32% of patients were post-gastric bypass (127) versus 4% of sleeve gastrectomy (8). In patients post-gastric bypass, 22 were found with delayed contrast passage, 3 possible obstruction, 4 possible leak, and only 1 definite leak. In patients post-sleeve gastrectomy, 2 had delayed passage of contrast without evidence of a leak. No leak was identified in 443 patients (77%) who did not undergo imaging. The sensitivity and specificity of UGI series for the detection of leak in gastric bypass patients were 100% and 97%, respectively, and the positive and negative predictive values were 20% and 100%, respectively. On univariate and multivariate analysis, sleeve gastrectomy patients (OR 0.4 sleeve vs bypass; P < 0.01) and male patients (OR 0.4 M vs F; P 0.02) were less likely to undergo routine UGI series (OR 0.4 M vs F; P 0.02). CONCLUSION Routine UGI series may be of limited value for the detection of anastomotic leaks after gastric bypass or sleeve gastrectomy and patients should undergo routine imaging based on clinical parameters. Gastric bypass procedure and female gender were factors increasing the likelihood of routine post-operative UGI. Further larger scale analysis of this important topic is warranted.
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Affiliation(s)
- Ketan Dayma
- Department of Radiology, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| | - Aruna David
- Department of Radiology, Harlem Hospital Center, New York, NY, 10037, USA
| | - Adil Omer
- Department of Radiology, Harlem Hospital Center, New York, NY, 10037, USA
| | - Haneen Abdel-Dayam
- Department of Radiology, Harlem Hospital Center, New York, NY, 10037, USA
| | - Anan Tawil
- Department of Surgery, Harlem Hospital Center, New York, NY, 10037, USA
| | - Nicholas Socci
- Department of Bioinformatics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10021, USA
| | - Leaque Ahmed
- Department of Radiology, Harlem Hospital Center, New York, NY, 10037, USA
| | - Anthony Gilet
- Department of Radiology, Harlem Hospital Center, New York, NY, 10037, USA
- Department of Radiology, Westchester Medical Center, Westchester, NY, 10595, USA
| | - Dana Haddad
- Department of Radiology, Harlem Hospital Center, New York, NY, 10037, USA.
- School of Medicine, Mohammed Bin Rashid University, Dubai, United Arab Emirates.
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6
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Wang Z, Gu D, Pan C, Zhou A, Chen H. Comparative observation on the effect of laparoscopic sleeve gastrectomy and routine weight loss in the treatment of obesity and the improvement of blood pressure. Panminerva Med 2024; 66:107-109. [PMID: 34544225 DOI: 10.23736/s0031-0808.21.04474-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Zhengdong Wang
- Department of Gastrointestinal Surgery, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Dezhi Gu
- Department of Gastrointestinal Surgery, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China -
| | - Cheng Pan
- Department of Gastrointestinal Surgery, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Aiming Zhou
- Department of Gastrointestinal Surgery, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Huiyu Chen
- Department of Gastrointestinal Surgery, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
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Trac J, Balas M, Gee D, Hutter MM, Jung JJ. Does routine upper gastrointestinal swallow study after metabolic and bariatric surgery lead to earlier diagnosis of leak? Surg Obes Relat Dis 2024:S1550-7289(24)00077-7. [PMID: 38570283 DOI: 10.1016/j.soard.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/14/2024] [Accepted: 02/17/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND It is unclear whether routine upper gastrointestinal swallow study (SS) in the immediate postoperative period is associated with earlier diagnosis of gastrointestinal leak after bariatric surgery. OBJECTIVE To investigate the relationship between routine SS and time to diagnosis of postoperative gastrointestinal leak. SETTING MBSAQIP-accredited hospitals in the United States and Canada. METHODS We conducted an observational cohort study of adults who underwent laparoscopic primary Roux-en-Y gastric bypass (RYGB) (n = 82,510) and sleeve gastrectomy (SG) (n = 283,520) using the MBSAQIP 2015-2019 database. Propensity scores were used to match patient cohorts who underwent routine versus no routine SS. Primary outcome was time to diagnosis of leak. Median days to diagnosis of leak were compared. The Nelson-Aalen estimator was used to determine the cumulative hazards of leak. RESULTS In our study, 36,280 (23%) RYGB and 135,335 (33%) SG patients received routine SS. Routine SS was not associated with earlier diagnosis of leak (RYGB routine SS median 7 [IQR 3-12] days v. no routine SS 6 [2-11] days, P = .9; SG routine SS 15 [9-22] days v. no routine SS 14 [8-21] days, P = .06) or lower risk of developing leak (RYGB HR 1.0, 95%-CI .8-1.2; SG HR 1.1, 95%-CI 1.0-1.4). More routine SS patients had a length of stay 2 days or greater (RYGB 78.3% v. 61.1%; SG 48.6% v. 40.3%). CONCLUSIONS Routine SS was not associated with earlier diagnosis of leaks compared to the absence of routine SS. Surgeons should consider abandoning the practice of routine SS for the purpose of obtaining earlier diagnosis of postoperative leaks.
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Affiliation(s)
- Jessica Trac
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Michael Balas
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Denise Gee
- Division of General and Oncologic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Matthew M Hutter
- Division of General and Oncologic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - James J Jung
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Duke University, Durham, North Carolina.
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8
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Verras GI, Mulita F, Lampropoulos C, Kehagias D, Curwen O, Antzoulas A, Panagiotopoulos I, Leivaditis V, Kehagias I. Risk Factors and Management Approaches for Staple Line Leaks Following Sleeve Gastrectomy: A Single-Center Retrospective Study of 402 Patients. J Pers Med 2023; 13:1422. [PMID: 37763189 PMCID: PMC10532722 DOI: 10.3390/jpm13091422] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/26/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Sleeve gastrectomy (SG) has gained ever-increasing popularity among laparoscopic surgeons involved in bariatric surgery. This single-institution, retrospective cohort study aims to evaluate the prevalence of postoperative staple line leakage (PSLL) after LSG and identify risk factors for its development. We included patient data that underwent LSG at our institution for a span of 17 years-starting in January 2005 and ending in December 2022. We set the investigation of correlations of patient-related factors (age, weight, BMI, smoking status, presence of diabetes mellitus) with the occurrence of postoperative leaks. A total of 402 patients were included in our study. Of them, 26 (6.46%) developed PSLL. In total, 19 (73%) patients underwent percutaneous drainage and 14 patients (53.8%) were treated with intraluminal endoscopic stenting. Finally, five patients (19.2%) were treated with endoscopic clipping of the defect. Operative management was required in only one patient. There were no statistically significant differences in patient age, mean weight at the time of operation, and mean BMI. Abnormal drain amylase levels were associated with earlier detection of PSLL. More consideration needs to be given to producing a consensus regarding the management of PSLL, prioritizing nonoperative management with the combination of percutaneous drainage and endoscopic stenting as the safest and most efficient approach.
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Affiliation(s)
- Georgios-Ioannis Verras
- Department of Surgery, General University Hospital of Patras, 26504 Patras, Greece
- General Surgery, Epsom and St. Helier University Hospitals, National Health Service (NHS) Trust, London SM5 1AA, UK
| | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, 26504 Patras, Greece
| | | | - Dimitrios Kehagias
- Department of Surgery, General University Hospital of Patras, 26504 Patras, Greece
| | - Oliver Curwen
- General Surgery, Epsom and St. Helier University Hospitals, National Health Service (NHS) Trust, London SM5 1AA, UK
| | - Andreas Antzoulas
- General Surgery, Epsom and St. Helier University Hospitals, National Health Service (NHS) Trust, London SM5 1AA, UK
| | - Ioannis Panagiotopoulos
- Department of Cardiothoracic Surgery, General Hospital of Athens “Ippokrateio”, 11527 Athens, Greece
| | - Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, 67655 Kaiserslautern, Germany
| | - Ioannis Kehagias
- Department of Surgery, General University Hospital of Patras, 26504 Patras, Greece
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Diab ARF, Sher T, Awshah S, Noom M, Docimo S, Sujka JA, DuCoin CG. Oversewing/Suturing of the Staple Line During Sleeve Gastrectomy Is an Effective and Affordable Staple Line Reinforcement Method: a Meta-analysis of Randomized Controlled Trials. Obes Surg 2023; 33:2533-2545. [PMID: 37312007 DOI: 10.1007/s11695-023-06672-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/24/2023] [Accepted: 06/07/2023] [Indexed: 06/15/2023]
Abstract
Bleeding and leaks are the most ominous postoperative complications after laparoscopic sleeve gastrectomy (LSG). Various staple line reinforcement (SLR) techniques have been innovated such as oversewing/suturing (OS/S), omentopexy/gastropexy, buttressing, and gluing. Currently, no high-quality evidence supports the use of one method over the others or even supports the use of SLR over no SLR. This study aimed to compare postoperative outcomes between LSG with OS/S versus LSG without any SLR.
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Affiliation(s)
- Abdul-Rahman F Diab
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA.
| | - Theo Sher
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
| | - Sabrina Awshah
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
| | - Madison Noom
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
| | - Salvatore Docimo
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA
| | - Joseph A Sujka
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA
| | - Christopher G DuCoin
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA
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10
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Diab ARF, Alfieri S, Doyle W, Koussayer B, Docimo S, Sujka JA, DuCoin CG. Seamguard Buttressing of the Staple Line During Laparoscopic Sleeve Gastrectomy Appears to Decrease the Incidence of Postoperative Bleeding, Leaks, and Reoperations. A Systematic Review and Meta-Analysis of Non-Randomized Comparative Studies. Obes Surg 2023; 33:2237-2245. [PMID: 37204531 DOI: 10.1007/s11695-023-06649-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/07/2023] [Accepted: 05/12/2023] [Indexed: 05/20/2023]
Abstract
Leaks and bleeding are major acute postoperative complications following laparoscopic sleeve gastrectomy (LSG). Various staple line reinforcement (SLR) methods have been invented such as oversewing/suturing (OS/S), omentopexy/gastropexy (OP/GP), gluing, and buttressing. However, many surgeons do not use any type of reinforcement. On the other hand, surgeons who use a reinforcement method are often confused of what kind of reinforcement they should use. No robust and high-quality data supports the use of one reinforcement over the other or even supports the use of reinforcement over no-reinforcement. Therefore, SLR is a controversial topic that is worth our focus. The aim of this study is to compare the outcomes of LSG with versus without Seamguard buttressing of the staple line during LSG.
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Affiliation(s)
- Abdul-Rahman F Diab
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA.
| | - Sarah Alfieri
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
| | - William Doyle
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
| | - Bilal Koussayer
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
| | - Salvatore Docimo
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA
| | - Joseph A Sujka
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA
| | - Christopher G DuCoin
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA
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Oshiro T, Wakamatsu K, Nabekura T, Moriyama Y, Kitahara N, Kadoya K, Sato A, Kitahara T, Urita T, Sato Y, Nagashima M, Tsuchiya M, Okazumi S. Treatments for Staple Line Leakage after Laparoscopic Sleeve Gastrectomy. J Clin Med 2023; 12:jcm12103495. [PMID: 37240601 DOI: 10.3390/jcm12103495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/29/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
The number of laparoscopic sleeve gastrectomies (LSGs) performed in patients with obesity who are eligible for bariatric and metabolic surgery is currently much lower in Japan than in other countries. Considering the large number of potential patients with obesity and type 2 diabetes and the unique Japanese national health insurance system that guarantees fair healthcare delivery, there is room to increase the number of LSGs in Japan in the near future. However, strict health insurance regulations may limit access to mandatory devices needed to treat postoperative complications, such as staple line leakage, which can cause severe morbidity and even mortality. Therefore, understanding the pathogenesis and treatment options for this complication is crucial. This article examined the current situation in Japan and its impact on staple line leakage management, including the role of endoscopic treatment in reducing reoperation. The authors suggest increasing education and collaboration between healthcare professionals to optimize management and improve patient outcomes.
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Affiliation(s)
- Takashi Oshiro
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Kotaro Wakamatsu
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Taiki Nabekura
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Yuki Moriyama
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Natsumi Kitahara
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Kengo Kadoya
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Ayami Sato
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Tomoaki Kitahara
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Tasuku Urita
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Yu Sato
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Makoto Nagashima
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Masaru Tsuchiya
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Shinichi Okazumi
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
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Nedelcu M, Manos T, Noel P, Danan M, Zulian V, Vilallonga R, Nedelcu A, Carandina S. Is the Surgical Drainage Mandatory for Leak after Sleeve Gastrectomy? J Clin Med 2023; 12:jcm12041376. [PMID: 36835912 PMCID: PMC9963979 DOI: 10.3390/jcm12041376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION Despite the unanimous acknowledgement of the laparoscopic sleeve gastrectomy (LSG) worldwide, the leak remains its deficiency. For the last decade, the surgical treatment was practically considered mandatory for almost any collection following LSG. The aim of this study is to evaluate the need for surgical drainage for leak following LSG. METHODS All consecutive patients having gone through LSG from January 2017 to December 2020 were enrolled in our study. Once the demographic data and the leak history were registered, we analyzed the outcome of the surgical or endoscopic drainage, the characteristics of the endoscopic treatment, and the evolution to complete healing. RESULTS A total of 1249 patients underwent LSG and the leak occurred in 11 cases (0.9%). There were 10 women with a mean age of 47.8 years (27-63). The surgical drainage was performed for three patients and the rest of the eight patients underwent primary endoscopic treatment. The endoscopic treatment was represented with pigtails for seven cases and septotomy with balloon dilation for four cases. In two out of these four cases, the septotomy was anticipated by the use of a nasocavitary drain for 2 weeks. The average number of endoscopic procedures was 3.2 (range 2-6). The leaks achieved complete healing after an average duration of 4.8 months (range 1-9 months). No mortality was recorded for a leak. CONCLUSIONS The treatment of the gastric leak must be tailored to each patient. Although there is still no consensus for the endoscopic drainage of leaks after LSG, the surgical approach can be avoided in up to 72%. The benefits of pigtails and nasocavitary drains followed by endoscopic septotomy are undeniable, and they should be included in the armamentarium of any bariatric center.
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Affiliation(s)
- Marius Nedelcu
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Óbesite, 83000 Toulon, France
- ELSAN, Clinique Bouchard, 13006 Marseille, France
- Correspondence: ; Tel.: +33-695-950-965
| | - Thierry Manos
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Óbesite, 83000 Toulon, France
| | - Patrick Noel
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Óbesite, 83000 Toulon, France
- Emirates Specialty Hospital, Dubai Healthcare City, Dubai 505240, United Arab Emirates
- Mediclinic Airport Road Hospital, Abu Dhabi 48481, United Arab Emirates
| | - Marc Danan
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Óbesite, 83000 Toulon, France
| | - Viola Zulian
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Óbesite, 83000 Toulon, France
| | - Ramon Vilallonga
- ELSAN, Clinique Bouchard, 13006 Marseille, France
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Hospital Vall d’Hebron, 08035 Barcelona, Spain
- Surgery Department, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | | | - Sergio Carandina
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Óbesite, 83000 Toulon, France
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Park JY. Diagnosis and Management of Postoperative Complications After Sleeve Gastrectomy. JOURNAL OF METABOLIC AND BARIATRIC SURGERY 2022; 11:1-12. [PMID: 36685085 PMCID: PMC9848960 DOI: 10.17476/jmbs.2022.11.1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 01/24/2023]
Abstract
Sleeve gastrectomy (SG) has demonstrated excellent outcomes in terms of weight loss and resolution of obesity-related comorbidities as a single procedure. It has gained rapidly increasing popularity among bariatric surgeons and patients over the last two decades. This is due to its relative ease of use and less frequent morbidities related to the procedure. Even though the overall complication rate after SG is reported to be lower than conventional Roux-en-Y gastric bypass or biliopancreatic diversion, it still affects 1-10% of the patients undergoing SG, which is not negligible. Early postoperative complications that can occur within 30 days after SG include hemorrhage, leakage, sleeve stenosis, and reflux. Thromboembolic events are rare but can occur after surgery. Here, we review the incidence, diagnosis, and management of these early postoperative complications.
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Affiliation(s)
- Ji Yeon Park
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.,Department of Surgery, Kyungpook National University Chilgok Hospital, Daegu, Korea
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14
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MEOLI F, CORALLINO D, PALMIERI L, CORDOVA HERENCIA IE, PAGANINI AM. Total gastrectomy after endotherapy failure for management of chronic gastric leakage from sleeve gastrectomy: the end of a nightmare. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.20.05193-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Alolayan H, Aldubayyan A, Aldhohayan A, AlBassam R, Almarzuqi S, Almoqaiteb T, Almutlaq G, Alquwayfili L. General Public Awareness about the Indications and Complications of Sleeve Gastrectomy in Qassim Region, Saudi Arabia. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Sleeve gastrectomy has become prevalent worldwide regardless of the patient’s awareness about the indications and complications. That would affect their judgment and decision.
AIM: This study aimed to assess the level of awareness about indications and complications of sleeve gastrectomy in the general public at Al-Qassim, Saudi Arabia in 2021.
MATERIALS AND METHODS: This is a quantitative cross-sectional study conducted among the general public living in the Qassim region, Saudi Arabia. Using a convenience sampling technique to select the participants as a representative sample for the general population. The target population will include all Saudis, who live in Al-Qassim and aged above 18 years, and will exclude who does not live in al-Qassim, age under 18 years, non-Saudi, who does not complete the questionnaire and who refuse to participate. The data were collected using a validated self-administered questionnaire. Questionnaires include; demographic characteristics, general awareness about sleeve gastrectomy, and awareness toward the indication and complication of sleeve gastrectomy. All statistical analyses were performed using Statistical Packages for Software Sciences version 26.
RESULTS: A total of 1091 respondents took part. The mean age of the respondents was 37.5 (SD 12.9) years old with females dominating the males (87.8% vs. 12.2%). Awareness about the indications and complications of sleeve gastrectomy constitutes 49% and 82.4%, respectively. In univariate analyses, those who have heard about body mass index (BMI) had greater knowledge of the indications and complications of sleeve gastrectomy. In a multivariate regression model, gender female was the independent significant predictor of sleeve gastrectomy complications whereas those who heard of BMI was the independent significant predictor of the knowledge toward the indications and complications of sleeve gastrectomy.
CONCLUSION: The general public demonstrated a lack of knowledge regarding the indications of sleeve gastrectomy but their knowledge about complications was better. Better knowledge about BMI comes with a better awareness of the indications and complications of sleeve gastrectomy.
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16
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Yu Q, Saeed K, Okida LF, Gutierrez Blanco DA, Lo Menzo E, Szomstein S, Rosenthal R. Outcomes of laparoscopic sleeve gastrectomy with and without antrectomy in severely obese subjects. Evidence from randomized controlled trials. Surg Obes Relat Dis 2021; 18:404-412. [PMID: 34933811 DOI: 10.1016/j.soard.2021.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/02/2021] [Accepted: 11/12/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (SG) has been proven safe and effective in achieving weight loss. However, the distance from the pylorus where resection should begin has been debated. OBJECTIVES To compare the clinical outcomes of laparoscopic SG with antrum resection (AR) versus preservation (AP) for bariatric purposes by conducting a meta-analysis of randomized controlled trials (RCT). SETTING Academic hospital, United States. METHODS PubMed and Cochrane Library were queried for RCTs from establishment to August 2020. The following key search terms were used: "sleeve gastrectomy" AND ("antrectomy" OR "antrum") AND ("randomized" OR "random"). The following data were extracted: author, publication year, country, sample size, follow-up duration, and clinical outcomes, including weight-related: excess weight loss (EWL), total weight loss (TWL), body mass index (BMI), operation time, length of hospital stay, complication rates, and resolution of obesity-related comorbidities. RESULTS A total of 9 unique RCTs including 492 AR and 385 AP patients were screened and included in the final quantitative analysis. Patients who underwent SG with AR showed higher EWL and TWL at 6 months (EWL: P < .001; TWL: P = .006), and 1 year (EWL: P = .013; P < .001) postoperatively. The BMI was also lower in the AR group 3 months (P = .013) and 6 months (P = .003) postoperatively. However, the EWL and BMI at 2 years were comparable between both groups (P = .222 and P = .908, respectively). No statistical significance was observed in terms of operating time, staple line disruption, bleeding, complications with a Clavien-Dindo Grade >III, resolution of comorbidities (hypertension, diabetes, hyperlipidemia, arthritis/back pain), and de novo gastroesophageal reflux disease (P > .05). AP was associated with a slightly shorter postoperative hospital stay (4.0 versus 3.1 days, P = .039). CONCLUSION Laparoscopic SG with AR is associated with superior weight loss in the short-term compared with AP. However, mid-term follow-up beyond 1 year showed no significant differences in BMI or incidence of de novo gastroesophageal reflux disease.
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Affiliation(s)
- Qian Yu
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Kashif Saeed
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Luis Felipe Okida
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida
| | | | - Emanuele Lo Menzo
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Samuel Szomstein
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Raul Rosenthal
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida.
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Catchlove W, Johari Y, Forrest E, Au A, Shaw K, Nottle P, Ellis S, Brown WA, Burton P. Initial radiologic appearance rather than management strategy predicts the outcomes of sleeve gastrectomy leaks. Surg Obes Relat Dis 2021; 18:205-216. [PMID: 34952796 DOI: 10.1016/j.soard.2021.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/14/2021] [Accepted: 11/07/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Initial radiologic appearance rather than management strategy predicts the outcomes of sleeve gastrectomy leaks. OBJECTIVE Multiple modalities have been advocated for the treatment of sleeve gastrectomy leak, and there remains no consensus on the best treatment paradigm. For more than 10 years, we have variably attempted luminal occlusive therapies and repeated endoscopic debridement as treatment options. By evaluating the outcomes from these approaches, we aimed to determine whether the first management strategy is superior to the second in terms of outcomes. METHODS Patients were analyzed by group (luminal occlusive therapy versus repeated endoscopic debridement). Leaks were then stratified by radiologic appearance on computed tomography, defined as phlegmon, collection, contrast medium leak, or fistula. The primary outcome was length of stay (LOS). Secondary outcomes were comprehensive complication index and the need for resection. RESULTS There were 54 patients, with 22 in the luminal occlusion group and 32 in the repeated debridement group. There was no difference in LOS (59.8 ± 41.6 versus 46.5 ± 51.2 days, P = .179) and no difference in the requirement for resection (4 versus 3 resections, p = .425). Subset analysis suggested that patients who underwent operative versus conservative management (P = .006) had a longer LOS. Excluding management strategy, radiologic appearance on admission significantly predicted LOS (P = .0053). Patients presenting with fistula (84 ± 25.4 days) and contrast medium leak (64.1 ± 40 days) had a significantly longer LOS than those diagnosed with phlegmon (13.5 ± 5.5 days). Radiologic appearance was predictive of complication severity (P < .0001) and salvage resection (P = .008). CONCLUSION There was no significant difference in outcomes between patients treated with intraluminal occlusion or repeated debridement. Initial radiologic appearance was predictive of LOS and complication severity. This highlights the need for routine use of a validated classification system in studies reporting outcomes and treatment of sleeve leaks.
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Affiliation(s)
- William Catchlove
- Oesophago-Gastric Bariatric Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Surgery, Monash University, and Centre for Obesity Research and Education, Alfred Hospital, Melbourne, Victoria, Australia.
| | - Yazmin Johari
- Oesophago-Gastric Bariatric Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Surgery, Monash University, and Centre for Obesity Research and Education, Alfred Hospital, Melbourne, Victoria, Australia
| | - Edward Forrest
- Oesophago-Gastric Bariatric Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Amos Au
- Oesophago-Gastric Bariatric Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Kalai Shaw
- Department of Surgery, Monash University, and Centre for Obesity Research and Education, Alfred Hospital, Melbourne, Victoria, Australia
| | - Peter Nottle
- Oesophago-Gastric Bariatric Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Samantha Ellis
- Department of Radiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Wendy A Brown
- Oesophago-Gastric Bariatric Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Surgery, Monash University, and Centre for Obesity Research and Education, Alfred Hospital, Melbourne, Victoria, Australia
| | - Paul Burton
- Oesophago-Gastric Bariatric Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Surgery, Monash University, and Centre for Obesity Research and Education, Alfred Hospital, Melbourne, Victoria, Australia
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18
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Gjeorgjievski M, Imam Z, Cappell MS, Jamil LH, Kahaleh M. A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks. J Clin Gastroenterol 2021; 55:551-576. [PMID: 33234879 DOI: 10.1097/mcg.0000000000001451] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bariatric surgery leaks result in significant morbidity and mortality. Experts report variable therapeutic approaches, without uniform guidelines or consensus. OBJECTIVE To review the pathogenesis, risk factors, prevention, and treatment of gastric sleeve leaks, with a focus on endoscopic approaches. In addition, the efficacy and success rates of different treatment modalities are assessed. DESIGN A comprehensive review was conducted using a thorough literature search of 5 online electronic databases (PubMed, PubMed Central, Cochrane, EMBASE, and Web of Science) from the time of their inception through March 2020. Studies evaluating gastric sleeve leaks were included. MeSH terms related to "endoscopic," "leak," "sleeve," "gastrectomy," "anastomotic," and "bariatric" were applied to a highly sensitive search strategy. The main outcomes were epidemiology, pathophysiology, diagnosis, treatment, and outcomes. RESULTS Literature search yielded 2418 studies of which 438 were incorporated into the review. Shock and peritonitis necessitate early surgical intervention for leaks. Endoscopic therapies in acute and early leaks involve modalities with a focus on one of: (i) defect closure, (ii) wall diversion, or (iii) wall exclusion. Surgical revision is required if endoscopic therapies fail to control leaks after 6 months. Chronic leaks require one or more endoscopic, radiologic, or surgical approaches for fluid collection drainage to facilitate adequate healing. Success rates depend on provider and center expertise. CONCLUSION Endoscopic management of leaks post sleeve gastrectomy is a minimally invasive and effective alternative to surgery. Their effect may vary based on clinical presentation, timing or leak morphology, and should be tailored to the appropriate endoscopic modality of treatment.
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Affiliation(s)
- Mihajlo Gjeorgjievski
- Departments of Gastroenterology & Hepatology
- Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical Center, New Brunswick, NJ
| | - Zaid Imam
- Departments of Gastroenterology & Hepatology
- Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Mitchell S Cappell
- Departments of Gastroenterology & Hepatology
- Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Laith H Jamil
- Departments of Gastroenterology & Hepatology
- Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Michel Kahaleh
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical Center, New Brunswick, NJ
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19
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Comparison of the Intragastric Volume and Pressure required to Cause a Leak Along the Suture Line in a Resected Stomach Post Sleeve Gastrectomy. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02897-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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20
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Mohamed AA, Humaida AA, Qureshi AS. Delayed Post-Laparoscopic Sleeve Gastrectomy Leak Successfully Treated With Endoscopic Clips and Tissue Adhesive: Case Report and Literature Review. Cureus 2021; 13:e14532. [PMID: 34012739 PMCID: PMC8127644 DOI: 10.7759/cureus.14532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Since it was first introduced, laparoscopic sleeve gastrectomy (LSG) has gained wide popularity and it is one of the most performed bariatric surgical procedures for weight reduction throughout the world. LSG is a simple and effective procedure for the reduction of excess body weight, but it is not without serious complications. We present a case of a 46-year-old obese male with multiple co-morbidities who presented with a delayed post-LSG leak that was successfully managed with endoscopic clips and tissue adhesive.
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Affiliation(s)
- Abbas A Mohamed
- Department of General and Laparoscopic Surgery, National Guard Hospital, Al Madinah, SAU
| | - Ahmed A Humaida
- Department of Internal Medicine, National Guard Hospital, Al Madinah, SAU
| | - Ahmad S Qureshi
- Department of Internal Medicine, National Guard Hospital, Al Madinah, SAU
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21
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Rebibo L, Tricot M, Dembinski J, Dhahri A, Brazier F, Regimbeau JM. Gastric leak after sleeve gastrectomy: risk factors for poor evolution under conservative management. Surg Obes Relat Dis 2021; 17:947-955. [PMID: 33640258 DOI: 10.1016/j.soard.2021.01.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/16/2020] [Accepted: 01/21/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Gastric leak (GL) is the most highly feared early postoperative complication after sleeve gastrectomy (SG), with an incidence of 1% to 2%. This complication may require further surgery/endoscopy, with a risk of management failure that may require additional surgery, including total gastrectomy, leading to a risk of mortality of 0% to 9%. OBJECTIVES Assess the impact of factors that may lead to a poorer evolution of GL. SETTING University Hospital, France, public practice. METHODS This was a retrospective, single-center study of a group of patients managed for GL after SG between November 2004 and January 2019 (n = 166). Forty-three patients were excluded. The population study was divided into 2 groups: patients with easy closing of the GL (n = 73) and patients with difficult closing of the GL or failure to heal (n = 50). Patients were allocated to 1 of 2 groups depending on the time to heal (median time of 84 days). The study's primary efficacy endpoint was to determine the risk factors for a poorer evolution of GL. RESULTS Among 123 patients included in this study, 103 patients had undergone primary SG (83.7%). The mean time to the appearance of GL was 15.1 days (range, 1-156 d). Seventy-four patients underwent a reoperation (60%). The mean number of endoscopies per patient was 2.7 (range, 2-7 endoscopies). The mean time to healing was 89.5 days (range, 18-386 d). There were 8 cases of healing failure (6.5%). Multivariate analysis identified body mass index (>47 kg/m2), time to referral (>2 d), and serum prealbumin level (<.1 g/dL) to be independent risk factors for a poorer evolution of GL. CONCLUSION Improvement of nutritional status before SG and early referral for GL could reduce the risk of delayed closure or the need for further surgery.
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Affiliation(s)
- Lionel Rebibo
- Department of Digestive, Esogastric, and Bariatric Surgery, Bichat Claude Bernard University Hospital, Paris, France; Université de Paris, Inserm UMR 1149 F-75018 Paris, France
| | - Meghane Tricot
- Department of Digestive Surgery, Amiens University Medical Center, Amiens, France
| | - Jeanne Dembinski
- Department of Digestive Surgery, Amiens University Medical Center, Amiens, France
| | - Abdennaceur Dhahri
- Department of Digestive Surgery, Amiens University Medical Center, Amiens, France
| | - Franck Brazier
- Department of Hepato-Gastroenterology, Amiens University Medical Center, Amiens, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens University Medical Center, Amiens, France; Simplification of Surgical Patient Care Clinical Research Unit, University of Picardie Jules Verne, Amiens, France.
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22
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A 4-tier Protocolized Radiological Classification System for Leaks Following Sleeve Gastrectomy. Ann Surg 2021; 275:e401-e409. [PMID: 33470630 DOI: 10.1097/sla.0000000000003984] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To develop and validate a classification of sleeve gastrectomy leaks able to reliably predict outcomes, from protocolized computed tomography (CT) findings and readily available variables. SUMMARY OF BACKGROUND DATA Leaks post sleeve gastrectomy remain morbid and resource-consuming. Incidence, treatments, and outcomes are variable, representing heterogeneity of the problem. A predictive tool available at presentation would aid management and predict outcomes. METHODS From a prospective database (2009-2018) we reviewed patients with staple line leaks. A Delphi process was undertaken on candidate variables (80-20). Correlations were performed to stratify 4 groupings based on outcomes (salvage resection, length of stay, and complications) and predictor variables. Training and validation cohorts were established by block randomization. RESULTS A 4-tiered classification was developed based on CT appearance and duration postsurgery. Interobserver agreement was high (κ=0.85, P<0.001). There were 59 patients, (training: 30, validation: 29). Age 42.5±10.8 versus 38.9±10.0 years (P=0.187); female 65.5% versus 80.0% (P=0.211), weight 127.4±31.3 versus 141.0±47.9 kg, (P=0.203). In the training group, there was a trend toward longer hospital stays as grading increased (I=10.5 d; II=24 d; III=66.5 d; IV=72 d; P= 0.005). Risk of salvage resection increased (risk ratio grade 4=9; P=0.043) as did complication severity (P=0.027). Findings were reproduced in the validation group: risk of salvage resection (P=0.007), hospital stay (P=0.001), complications (P=0.016). CONCLUSION We have developed and validated a classification system, based on protocolized CT imaging that predicts a step-wise increased risk of salvage resection, complication severity, and increased hospital stay. The system should aid patient management and facilitate comparisons of outcomes and efficacy of interventions.
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23
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Hany M, Ibrahim M, Zidan A, Samir M, Elsherif A, Selema M, Sharaan M, Elhashash M. Role of Primary Use of Mega Stents Alone and Combined with Other Endoscopic Procedures for Early Leak and Stenosis After Bariatric Surgery, Single-Institution Experience. Obes Surg 2021; 31:2050-2061. [PMID: 33409972 DOI: 10.1007/s11695-020-05211-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Surgical therapy for post-bariatric surgery complications is associated with significant morbidity and mortality. Endoscopic options like primarily endoscopically placed fully covered self-expandable metallic stents (SEMS) offer significant benefits for the management of leaks and obstructions or stenosis, and even in case of mega stent failure, further endoscopic techniques could resolve the situation. MATERIALS AND METHODS We conducted a single-centre retrospective study on patients with leakage and stenosis/obstruction after bariatric surgery who were managed primarily by SEMS between January 2015 and January 2019. Clinical success rate was evaluated in terms of the cure of the reason for stenting, the need for other interventions, and the presentation of stent-related complications. RESULTS There were 58 patients included, (50 with leak, 8 with stenosis/obstruction following bariatric surgery). Mean time to stent placement was 6.82 (±1.64) days for the leak group and 35 (±21.13) days for the stenosis group (p = 0.019). Successful outcomes with SEMS alone were achieved in 42 (72.41%) patients, while 16 patients had failed SEMS treatment, of whom 14 were successfully managed by endoscopic procedures while two cases needed surgical intervention. Of the SEMS-related complications encountered, 25.86% were ulcers; 24.13%, vomiting; 22.41%, gastroesophageal reflux disease (GerdQ≥8); 18.96%, stent migration; and 5.17%, stent intolerance. CONCLUSION A mega stent is an effective and safe tool for the early management of post-bariatric surgery leakage and stenosis, and it is associated with acceptable rates of failure that can be managed by further endoscopic techniques in most of the patients.
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Affiliation(s)
- Mohamed Hany
- Surgical Endoscopy and Gastrointestinal Motility Unit, Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt.
| | - Mohamed Ibrahim
- Surgical Endoscopy and Gastrointestinal Motility Unit, Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Ahmed Zidan
- Surgical Endoscopy and Gastrointestinal Motility Unit, Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Mohamed Samir
- Surgical Endoscopy and Gastrointestinal Motility Unit, Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Amr Elsherif
- Surgical Endoscopy and Gastrointestinal Motility Unit, Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Mohamed Selema
- Surgical Endoscopy and Gastrointestinal Motility Unit, Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Mohamed Sharaan
- Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed Elhashash
- Surgical Endoscopy and Gastrointestinal Motility Unit, Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
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24
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Balagué C, Ruiz de Adana JC, Ibarzabal A, Del Castillo D, Puche JJ, Vilallonga R. Insights into the treatment of postsleeve gastrectomy leak: analysis of the results of 105 cases on a national register. Surg Obes Relat Dis 2020; 17:36-43. [PMID: 33097450 DOI: 10.1016/j.soard.2020.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 06/16/2020] [Accepted: 09/02/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Many options have been put forward to treat staple line leaks after sleeve gastrectomy (SG) but no clear consensus has emerged concerning a management algorithm. OBJECTIVES Aiming to establish a pattern to tailor treatment, the Spanish Society of Obesity Surgery (SECO) and the Obesity Section of the Spanish Association of Surgeons (AEC) set up a national register to record treatment of leaks after SG. SETTING Multiple hospital centers, Spain. METHODS Between September 2016 and December 2017, cases were entered into an online database. Results were assessed according to the number and type of therapeutic procedures. RESULTS One hundred and five patients from 27 centers were diagnosed with postSG leak. The mean age was 44 years, and 77 (73%) were women. Mean body mass index (BMI) was 47 kg/m2. Mortality was 7%. The first treatment was effective in 50% of cases with no significant differences between nonoperative management and surgery. We found no significant correlations between appearance of leak, type of treatment (nonoperative management or surgery), and treatment effectiveness. An endoscopic stent was the first nonoperative option in 30% of cases and second option in 50% of cases, with effectiveness of 61% and 50%, respectively. In patients requiring a third treatment option (n = 25), surgery was more effective than nonoperative treatment (75% versus 8%) and the incidence of complications secondary to endoscopic stent placement was high (71%). CONCLUSION The choice of postSG leak treatment depends on the patient's clinical condition and the site of the leak. Healing may be slow (>2 months) and may require several interventions using different approaches such as nonoperative treatment, endoscopic stents, or surgery. The effectiveness of endoscopic options decreases and the effectiveness of complex resective or derivative surgery increases with leak duration and the number of treatments required.
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Affiliation(s)
- Carmen Balagué
- General and Digestive Surgery, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | | | - Ainitze Ibarzabal
- General and Digestive Surgery, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - José Julian Puche
- General and Digestive Surgery, Hospital Gral Universitario, Valencia, Spain
| | - Ramón Vilallonga
- General and Digestive Surgery, Hospital de la Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Challenges in the Diagnosis of Leak After Sleeve Gastrectomy: Clinical Presentation, Laboratory, and Radiological Findings. Obes Surg 2020; 31:612-616. [PMID: 33025538 PMCID: PMC7847981 DOI: 10.1007/s11695-020-05008-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/18/2020] [Accepted: 09/23/2020] [Indexed: 12/20/2022]
Abstract
Background The presentation of leak after laparoscopic sleeve gastrectomy (LSG) is variable. A missed or delayed diagnosis can lead to severe consequences. This study presents our experience: the clinical presentations, laboratory, and radiological findings in patients with leak after LSG. Methods A retrospective review of patients who were diagnosed and treated as leak after LSG at our center (January 2012–November 2019). Results Eighty patients developed leak: 68 (85%) after primary LSG, 6 (7.5%) after Re-LSG and 6 (7.5%) after band removal to revisional LSG. Mean age 35.9 ± 10 years. The diagnosis was within 18 ± 14 days after surgery. Five (6.3%) patients were diagnosed during the same admission. Only 29.3% of patients were diagnosed correctly from the first visit to the ER. Most were misdiagnosed as gastritis (49%) and pneumonia (22.6%). Thirty-four patients (45.3%) were diagnosed correctly at the third visit. The most common presenting symptoms were abdominal pain (90%), tachycardia (71.3%), and fever (61.3%). The mean white blood cells (WBCs) count was 14700 ± 5900 (cells/mm3), c-reactive protein (CRP) 270 ± 133 mg/L, lactic acid 1.6 ± 0.85 mmol/L, and albumin 30.3 ± 6.6 g/L. The abdominal CT scans revealed intraabdominal collection in 93.7% of patients, extravasation of contrast in 75%, and pleural effusion in 52.5%. Upper gastrointestinal contrast study (UGIC) showed extravasation of contrast in 77.5% of patients. Conclusion Abdominal pain, tachycardia, or fever after LSG should raise the suspicion of a leak. CT scan of the abdomen and UGIC study detected leaks in 75% and 77.5% consecutively. Only 29.3% of patients were diagnosed correctly as a leak from the first visit to the ER.
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da Rocha JO, Matkovski PD, Zucco FM, Ristow BD, Moraes P, Koleski FJ, Pinto RD, Ponce FSDA. Portal vein thrombosis in laparoscopic vertical gastrectomy - laparoscopic sleeve gastrectomy: a case series. J Vasc Bras 2020; 19:e20200013. [PMID: 34178076 PMCID: PMC8202208 DOI: 10.1590/1677-5449.200013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Grade III obesity is defined as excessive accumulation of fat in the body in a person
with a BMI>40kg/m2 and is related to a series of comorbidities. It is
therefore of fundamental importance that appropriate treatment is adopted to reduce
its harmful effects on health. Laparoscopic vertical gastrectomy is well-established
for treatment of grade III obesity. Although rare, portal vein thrombosis is one of
the most serious of possible postoperative complications. In our study, eight cases
are analyzed of laparoscopic vertical gastrectomy patients who developed portal vein
thrombosis as a postoperative complication. In our series, we observed an increase in
the incidence of portomesenteric venous thrombosis, especially among patients who did
not follow the recommendations for oral hydration in the postoperative period. Most
patients with this complication respond positively to anticoagulation, with complete
or partial recanalization of the portal vein. Treatment with anticoagulants is
effective and should be considered the first option. Vigorous hydration has also been
shown to be an essential conduct in the postoperative period of these patients, and
should always be encouraged.
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Affiliation(s)
- Jorge Oliveira da Rocha
- Hospital Santa Catarina - HSC, Angioklinik, Cirurgia Vascular e Radiologia Intervencionista, Blumenau, SC, Brasil
| | - Paula Dayana Matkovski
- Universidade Federal do Paraná - UFPR, Departamento de Ciências da Saúde, Curitiba, PR, Brasil
| | - Fabrício Martins Zucco
- Hospital Santa Catarina - HSC, Angioklinik, Cirurgia Vascular e Radiologia Intervencionista, Blumenau, SC, Brasil
| | - Bernardo Dalago Ristow
- Hospital Santa Catarina - HSC, Angioklinik, Cirurgia Vascular e Radiologia Intervencionista, Blumenau, SC, Brasil
| | - Patrícia Moraes
- Hospital Santa Catarina - HSC, Angioklinik, Cirurgia Vascular e Radiologia Intervencionista, Blumenau, SC, Brasil
| | - Felipe José Koleski
- Hospital Santa Catarina - HSC, Vidar Clínica e Cirurgia, Blumenau, SC, Brasil
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Uccelli M, Targa S, Cesana GC, Oldani A, Ciccarese F, Giorgi R, De Carli SM, Olmi S. Use of fibrin glue in bariatric surgery: analysis of complications after laparoscopic sleeve gastrectomy on 450 consecutive patients. Updates Surg 2020; 73:305-311. [PMID: 32785854 DOI: 10.1007/s13304-020-00865-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/07/2020] [Indexed: 02/07/2023]
Abstract
Laparoscopic Sleeve Gastrectomy (LSG) is one of the most performed surgical procedures in bariatric surgery. Staple line leak and bleeding are by far the two most feared complications after LSG. In this study, we retrospectively compared the efficacy of Fibrin Glue in preventing staple line leak and bleeding. From September 2019 to January 2020, 450 obese patients underwent elective LSG and were placed into groups with Fibrin Glue reinforcement (Group A) or without Fibrin Glue reinforcement (Group B). Primary endpoints were postoperative staple line leak and bleeding; while, secondary endpoints were reintervention rate, total operative time and mortality. Mean Body Mass Index (BMI) was 45.4 ± 7.9 kg/m2 (range: 35.1-81.8). Mean age was 43.3 ± 11.8 years (range: 18-65). No intraoperative complications or conversion to laparotomy were reported. Mean operative time was comparable between the groups (48 ± 18 min in Group A vs 48 ± 14 min in Group B; p > 0.05). No decrease in overall postoperative complications was found in Group A (5.1% vs 7.0%; p > 0.05), but after stratification according to Clavien-Dindo classification, we found a higher rate of Grade II (0.0% vs 1.6%; p < 0.05) and Grade IIIb (0.0% vs 1%; p < 0.05) complications in group B. Our study showed that Fibrin Glue as a reinforcement method during LSG is a reliable tool, without affecting the operative time of surgery and mortality. A significant reduction in complications (Clavien-Dindo grade II and grade IIIb) was observed in patients undergoing LSG with Fibrin Glue.
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Affiliation(s)
- Matteo Uccelli
- General and Oncologic Surgery Department-Centre of Bariatric Surgery, San Marco Hospital - Gruppo San Donato, Corso Europa, 7, 24040, Zingonia, BG, Italy
| | - Simone Targa
- General and Oncologic Surgery Department-Centre of Bariatric Surgery, San Marco Hospital - Gruppo San Donato, Corso Europa, 7, 24040, Zingonia, BG, Italy.
| | - Giovanni Carlo Cesana
- General and Oncologic Surgery Department-Centre of Bariatric Surgery, San Marco Hospital - Gruppo San Donato, Corso Europa, 7, 24040, Zingonia, BG, Italy
| | - Alberto Oldani
- General and Oncologic Surgery Department-Centre of Bariatric Surgery, San Marco Hospital - Gruppo San Donato, Corso Europa, 7, 24040, Zingonia, BG, Italy
| | - Francesca Ciccarese
- General and Oncologic Surgery Department-Centre of Bariatric Surgery, San Marco Hospital - Gruppo San Donato, Corso Europa, 7, 24040, Zingonia, BG, Italy
| | - Riccardo Giorgi
- General and Oncologic Surgery Department-Centre of Bariatric Surgery, San Marco Hospital - Gruppo San Donato, Corso Europa, 7, 24040, Zingonia, BG, Italy
| | - Stefano Maria De Carli
- General and Oncologic Surgery Department-Centre of Bariatric Surgery, San Marco Hospital - Gruppo San Donato, Corso Europa, 7, 24040, Zingonia, BG, Italy
| | - Stefano Olmi
- General and Oncologic Surgery Department-Centre of Bariatric Surgery, San Marco Hospital - Gruppo San Donato, Corso Europa, 7, 24040, Zingonia, BG, Italy
- University of Milan and Vita-Salute University San Raffaele, Milan, Italy
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Caiazzo R, Marciniak C, Wallach N, Devienne M, Baud G, Cazauran JB, Kipnis E, Branche J, Robert M, Pattou F. Malignant Leakage After Sleeve Gastrectomy: Endoscopic and Surgical Approach. Obes Surg 2020; 30:4459-4466. [DOI: 10.1007/s11695-020-04818-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Knight J, Krishnaraj A. Utility of 3-Week Follow-Up of Upper Gastrointestinal Study in Asymptomatic Patients Following Laparoscopic Sleeve Gastrectomy. Curr Probl Diagn Radiol 2020; 49:260-265. [DOI: 10.1067/j.cpradiol.2019.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 04/23/2019] [Accepted: 05/07/2019] [Indexed: 01/19/2023]
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Stefura T, Kacprzyk A, Droś J, Chłopaś K, Wysocki M, Rzepa A, Pisarska M, Małczak P, Pędziwiatr M, Nowakowski M, Budzyński A, Major P. The hundred most frequently cited studies on sleeve gastrectomy. Wideochir Inne Tech Maloinwazyjne 2020; 15:249-267. [PMID: 32489485 PMCID: PMC7233154 DOI: 10.5114/wiitm.2019.89392] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/21/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Sleeve gastrectomy (SG) is one of the most popular bariatric operations and one of the most frequently studied areas in bariatric surgery. AIM To summarise the characteristics of the most frequently cited studies focusing on SG. MATERIAL AND METHODS We used the Web of Science database to identify all studies focused on SG published from 2000 to 2018. The term "sleeve gastrectomy" and synonyms were used to reveal the 100 most cited records. RESULTS The most frequently cited publication had 493 citations. The highest mean number of citations per year was 73.00. Studies were most frequently published in the years 2010 and 2012. Articles were most commonly published in bariatric surgery-oriented journals. CONCLUSIONS Our study indicates an increase in medical researchers' interest in the subject of SG and underlines the need to perform studies with a higher level of evidence to further analyse the outcomes and basic science behind SG.
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Affiliation(s)
- Tomasz Stefura
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Artur Kacprzyk
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Droś
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Chłopaś
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Wysocki
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- Centre for Research, Training, and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Anna Rzepa
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Pisarska
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- Centre for Research, Training, and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Piotr Małczak
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- Centre for Research, Training, and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Michał Pędziwiatr
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- Centre for Research, Training, and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Michał Nowakowski
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Budzyński
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- Centre for Research, Training, and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Piotr Major
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- Centre for Research, Training, and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
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Management of 69 Gastric Leakages after 4294 Consecutive Sleeve: The Experience of a High Volume Bariatric Center. Obes Surg 2020; 30:3084-3092. [DOI: 10.1007/s11695-020-04658-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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32
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Anatomical Relations Between the Esogastric Junction, the Diaphragm, the Pleura, and the Left Lung in Chronic Esogastro-bronchial and/or Esogastro-pleural Fistulas After Sleeve Gastrectomy. Obes Surg 2020; 29:2814-2823. [PMID: 31069692 DOI: 10.1007/s11695-019-03912-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE Gastric fistula is a severe complication following sleeve gastrectomy (SG). Chronic gastric fistula can progress to complex anatomical situations, such as esogastro-bronchial and/or esogastro-pleural (EGBP) fistulas. We decided to analyze the anatomical characteristics of these EGBP fistulas after SG. METHODS Our work consisted of an analysis of the clinical, endoscopic, and radiological data of patients treated for EGBP fistulas after SG at the Georges Pompidou European Hospital from May 2009 to November 2017. RESULTS A total of 11 patients were retrospectively included with available complete clinical, endoscopic, and radiological data. The origin of the fistula was mostly at the top of the staple line. The fistula's termination was pleural in 5 patients (45%) and bronchial in 6 (55%). In bronchial fistulas, 2 were proximal and 4 were distal, with the left pulmonary posterolateral segment (S10) being reached in each case. The trans-diaphragmatic passage was through the left cupola in 9 out of 11 patients (82%). In 2 patients, the passage was trans-hiatal (18%). Interestingly, the 2 eso-bronchial fistulas had a trans-hiatal passage with a termination in the proximal bronchus, while the 4 gastro-bronchial fistulas had a trans-diaphragmatic passage with a termination in the distal bronchus. All pleural fistulas were gastric with a trans-diaphragmatic passage. CONCLUSIONS Esogastro-bronchial and gastro-pleural fistulas after SG originated mostly at the top of the staple line. Eso-bronchial fistulas had a trans-hiatal passage with a proximal bronchial termination, while gastro-bronchial fistulas had a trans-diaphragmatic passage with a distal bronchial termination.
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Alharbi SR. Computed Tomography-based Diagnosis of Post-laparoscopic Sleeve Gastrectomy Gastric Leak. J Clin Imaging Sci 2020; 10:8. [PMID: 32257584 PMCID: PMC7109466 DOI: 10.25259/jcis_5_2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 02/13/2020] [Indexed: 01/31/2023] Open
Abstract
Objective: Gastric leak post-laparoscopic sleeve gastrectomy may appear as a variety of computed tomography (CT) findings. We aimed to review the various CT findings sensitivity and specificity in confirmed cases of gastric leak. Materials and Methods: A retrospective review was performed for all patients who underwent sleeve gastrectomy, CT, and endoscopy for suspected leak between 2011 and 2018. All patients with positive CT findings for gastric leak were included in the study. Results: A total of 152 consecutive patients underwent CT for suspected post-sleeve gastrectomy gastric leak. Out of 152 patients, 88 had positive CT findings for gastric leak and underwent endoscopy. The CT findings sensitivity and specificity of perigastric collection without oral contrast leak were 61% and 88.8%, oral contrast leak were 28% and 100%, and gas leak were 10% and 77.7%, respectively. Conclusions: Perigastric fluid collection without contrast leak and with variable wall enhancement and gas content is the most common CT findings of post-sleeve gastrectomy gastric leak. Among various CT findings, it exhibits good diagnostic accuracy with 61% sensitivity and 88.8% specificity.
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Affiliation(s)
- Sultan R Alharbi
- Department of Radiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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34
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Lamoshi A, Chernoguz A, Harmon CM, Helmrath M. Complications of bariatric surgery in adolescents. Semin Pediatr Surg 2020; 29:150888. [PMID: 32238287 DOI: 10.1016/j.sempedsurg.2020.150888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Over the past decade, outcomes data have demonstrated the benefit of bariatric surgery in achieving both sustained weight loss and reversal of co-morbidities. Comparing these data to contemporary known risks of adolescent bariatric surgery informs the patients and providers considering bariatric procedures and provides insight into potential ways to reduce and manage complications. The goal of this article is to review the common surgical and postoperative complications following bariatric procedures and discuss approaches to improve their safety. A systematic review identifying bariatric surgery complications in adolescents was conducted. The review focused on the data relevant to adolescent bariatric surgery. However, when necessary, adult studies were used to address the gaps in available pediatric information. The data pertaining to the intraoperative, short term, and long term surgically related and nutritional related complications show that complication are declining with increasing experience. Specific recommendations and strategies to avoid major complications of bariatric surgery in adolescents are offered.
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Affiliation(s)
- Abdulrouf Lamoshi
- Oishei Children's Hospital, Pediatric Surgery Department, Buffalo, NY, USA
| | - Artur Chernoguz
- Floating Hospital for Children at Tufts Medical Center, Pediatric Surgery Division, Boston, MA, USA
| | - Carroll M Harmon
- Oishei Children's Hospital, Pediatric Surgery Department, Buffalo, NY, USA
| | - Michael Helmrath
- Cincinnati Children's Hospital Medical Center, Pediatric Surgery Division, Cincinnati, OH, USA.
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Bashah M, Khidir N, EL-Matbouly M. Management of leak after sleeve gastrectomy: outcomes of 73 cases, treatment algorithm and predictors of resolution. Obes Surg 2019; 30:515-520. [DOI: 10.1007/s11695-019-04203-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Abstract
Introduction
Gastric leak post laparoscopic sleeve gastrectomy (LSG) is a severe complication that has been reported in 1.5–3% of cases. Management algorithms of leak exist; however, no known factors predict the time to resolution. This study aims to share outcomes of our management algorithm of post LSG leak, including the rate of resolution, complications, admission to the intensive care unit, conversion to other techniques, and mortality. To determine if any factors can predict the resolution time.
Methods
A retrospective analysis of patients who had LSG leaks and was managed in the main tertiary center in Qatar (January 2012–December 2017).
Results
A total of seventy-three patients had post LSG leaks. Fifty-six (76.7%) underwent LSG outside our center. Thirteen leaks (17.8%) were after revisional LSG. Laparoscopic exploration was performed in twenty patients (27.4%) and feeding jejunostomy in nine patients (12.3%). Patients were followed up for 12 months. All healed within 8.8 ± 0.72 weeks. The resolution rate was (97.1%) without surgical conversion, while two patients required fistulo-jejunostomy. No patient died. Complications occurred; re-leak (14.9%) and splenic abscess (2.9%). Patients on jejunal feeding had shorter resolution time (HR = 2.7, P = 0.018), while patients on total parenteral nutrition and post-endoscopic dilatation had 66% and 50% increases in the resolution time; (HR = 0.34, P = 0.026) and (HR = 0.5, P = 0.047), respectively.
Conclusion
Management of post-LSG leak is multimodal. Our clinical experience demonstrated less urge to perform extensive surgical interventions. Patients on enteral feeding had shorter resolution time while patients with sleeve stricture had a longer time to resolution.
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The role of C-reactive protein after surgery for obesity and metabolic disorders. Surg Obes Relat Dis 2019; 16:99-108. [PMID: 31784329 DOI: 10.1016/j.soard.2019.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/17/2019] [Accepted: 10/08/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND C-reactive protein (CRP) rise might be different in patients with obesity due to chronic inflammation. OBJECTIVES The aim was to analyze postoperative CRP rise and its role as an early prognostic marker of infectious complications. SETTING Center of maximum care in Germany. METHODS Patients who underwent laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass, or laparoscopic one-anastomosis gastric bypass as primary treatment for severe obesity were included. Serum CRP and leukocyte count were measured preoperatively, on postoperative days (POD) 1 and 4 and were analyzed regarding sex, body mass index, waist circumference, obesity-associated diseases, laboratory measurements (glycosylated hemoglobin, triglycerides, cholesterol), surgical procedure, infectious complications, and infectious with anastomotic leakage. RESULTS Four hundred seventy-one patients underwent surgery. Postoperative CRP rise was similar across sexes but lower in the super-super obese group (P < .05) and higher in the gastric bypass groups (P < .05). Linear regression model showed, that the higher preoperative value of waist circumference, the higher the preoperative CRP (beta value: .159, P = .006) and the lower the postoperative CRP rise on POD1 (beta value: -.171, P = .004) and 4 (beta value: -.170, P = .003). Only in the laparoscopic one-anastomosis gastric bypass group did a higher glycosylated hemoglobin predict a higher postoperative CRP rise (POD1: beta value: .434, P = .012; POD4: beta value: .513, P = .006). Fourteen patients (3%) developed infections, 7 of whom (1.5%) had anastomotic leakage. Leukocyte count was no predictor of infectious complications. The cut-off for CRP was 80.5 mg/L (POD1) and 164 mg/L (POD4), with 57.1% and 85.7% sensitivity and 97.9% and 99.6% specificity for anastomotic leakage. CONCLUSION Standard postoperative CRP rises less in patients with higher waist circumference and super-super obesity, but more after gastric bypass procedures. CRP but not leukocyte count predicts early anastomotic healing after obesity surgery. These findings should be considered when interpreting CRP values in the routine clinical setting.
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A Complication of an Endoscopic Pigtail Stent Migration into the Cavity during Deployment as a Treatment for Gastric Leak. Case Rep Surg 2019; 2019:6974527. [PMID: 31583156 PMCID: PMC6754919 DOI: 10.1155/2019/6974527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022] Open
Abstract
Gastric leak following gastrointestinal surgery is the most dreadful complication, which implies long hospital stay, morbidities, and not irrelevant mortalities. There is no standard recommendation for treating postlaparoscopic sleeve gastrectomy leak, which makes its management challenging. Endoscopic internal drainage by double-pigtail drains currently became the recommended approach. Complications to this approach include bleeding, ulceration at the tip of the double-pigtail stent, and uncommon migration. Here, we report our experience with drain displacement into the cavity while deployment in a patient who experienced gastric leakage after undergoing sleeve gastrectomy.
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Musella M, Cantoni V, Green R, Acampa W, Velotti N, Maietta P, Cuocolo A. Efficacy of Postoperative Upper Gastrointestinal Series (UGI) and Computed Tomography (CT) Scan in Bariatric Surgery: a Meta-analysis on 7516 Patients. Obes Surg 2019. [PMID: 29516397 DOI: 10.1007/s11695-018-3172-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND To demonstrate the lack of utility and efficacy of routine early postoperative upper gastrointestinal study (UGI) in obese patients undergoing bariatric surgery and to show the higher efficacy of CT scan in cases of clinical suspicion of a leakage, a meta-analysis was performed. MATERIALS AND METHODS A literature search including articles published in last 18 years was performed. For both UGI and CT scan, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. A first analysis considered overall patients, and a second analysis considered only symptomatic patients. RESULTS Starting from 1233 eligible citations, 18 articles, including 7516 patients, were left. The pooled sensitivity was 54% for UGI (95% CI 34-74) with a high heterogeneity (I2 = 99.8%, p < .001), whereas CT scan showed a pooled sensitivity of 91% (95% CI 89-93) significantly higher than sensitivity of UGI series (p < 0.01), with a high heterogeneity (I2 = 98.9%, p < .001). In symptomatic patients the pooled sensitivity of UGI series was significantly lower than sensitivity of CT scan [49% (95% CI 31-68) vs 94% (95% CI 92-96), p < 0.01]. PPV showed a significant difference between UGI series and CT scan (54 vs 100%, p < 0.01). Specificity for UGI series was 98.6%, and specificity for CT scan was 99.7% (p = ns); the mean NPV was 96 and 98% for UGI series and CT scan (p = ns). CONCLUSIONS According to our results, a CT scan triggered by clinical suspicion must be considered the first-line procedure to detect a postoperative leak following primary sleeve gastrectomy or Roux-en-Y gastric bypass.
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Affiliation(s)
- Mario Musella
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II" - Via S. Pansini 5 Buildings 10/12, 80131, Naples, Italy.
| | - Valeria Cantoni
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II" - Via S. Pansini 5 Buildings 10/12, 80131, Naples, Italy
| | - Roberta Green
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II" - Via S. Pansini 5 Buildings 10/12, 80131, Naples, Italy
| | - Wanda Acampa
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II" - Via S. Pansini 5 Buildings 10/12, 80131, Naples, Italy
| | - Nunzio Velotti
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II" - Via S. Pansini 5 Buildings 10/12, 80131, Naples, Italy
| | - Paola Maietta
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II" - Via S. Pansini 5 Buildings 10/12, 80131, Naples, Italy
| | - Alberto Cuocolo
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II" - Via S. Pansini 5 Buildings 10/12, 80131, Naples, Italy
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Patients Remain at High Risk of Gallstones Development Late (10 y) After Sleeve Gastrectomy? Surg Laparosc Endosc Percutan Tech 2019; 29:451-455. [PMID: 31318846 DOI: 10.1097/sle.0000000000000700] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sleeve gastrectomy (SG) is an established bariatric procedure which produces substantial and rapid weight loss and hence can lead to an increase in gallstones development. OBJECTIVES To demonstrate the early and late appearance of gallstones after SG. MATERIALS AND METHODS A prospective protocol was established in consecutive patients submitted to SG. Clinical and ultrasound evaluations were performed early (1 to 2 y) and late after surgery (over 6 y). RESULTS From 109 patients included, 13 (13.1%) had a previous and 10 (10.1%) had simultaneous cholecystectomy at the time of SG. Therefore, 86 patients were submitted to surveillance. Seven patients were unreachable, leaving 79 patients for late follow-up. Forty-five patients (57%) had alithiasic gallbladder late after surgery, whereas 34 patients (43%) showed appearance of gallstone. From them, 53% developed gallstones late after surgery (mean, 7.5 y). Among the group with early development of stones, 69% were symptomatic and in the latter group only 17%. CONCLUSIONS Study with 92% of follow-up late after SG demonstrated a 43% development of gallstones: half earlier and half late after surgery. We emphasize the need for late control to detect the real appearance of gallstones after SG.
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Dammaro C, Lainas P, Dumont JL, Tranchart H, Donatelli G, Dagher I. Endoscopic Internal Drainage Coupled to Prompt External Drainage Mobilization Is an Effective Approach for the Treatment of Complicated Cases of Sleeve Gastrectomy. Obes Surg 2019; 29:2929-2935. [DOI: 10.1007/s11695-019-03933-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Hughes D, Hughes I, Khanna A. Management of Staple Line Leaks Following Sleeve Gastrectomy—a Systematic Review. Obes Surg 2019; 29:2759-2772. [DOI: 10.1007/s11695-019-03896-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Gagner M, Kemmeter P. Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review. Surg Endosc 2019; 34:396-407. [PMID: 30993513 PMCID: PMC6946737 DOI: 10.1007/s00464-019-06782-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/04/2019] [Indexed: 12/19/2022]
Abstract
Background Staple-line leaks following laparoscopic sleeve gastrectomy (LSG) remain a concerning complication. Staple-line buttressing is largely adopted as an acceptable reinforcement but data regarding leaks have been equivocal. This study compared staple-line leaks in five reinforcement options during LSG: no reinforcement (NO-SLR), oversewing (suture), nonabsorbable bovine pericardial strips (BPS), tissue sealant or fibrin glue (Seal), or absorbable polymer membrane (APM). Methods This systematic review study of articles published between 2012 and 2016 regarding LSG leak rates aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Variables of interest included leak rates, bleeding, and complications in addition to surgical and population parameters. An independent Fisher’s exact test was used to compare the number of patients with and without leaks for the different reinforcement options. Results Of the 1633 articles identified, 148 met inclusion criteria and represented 40,653 patients. Differences in age (older in APM; p = 0.001), starting body mass index (lower in Suture; p = 0.008), and distance from pylorus (closer in BPS; p = 0.04) were observed between groups, but mean bougie size was equivalent. The overall leak rate of 1.5% (607 leaks) ranged from 0.7% for APM (significantly lower than all groups; p ≤ 0.007 for next lowest leak rate) to 2.7% (BPS). Conclusions This systematic review of staple-line leaks following LSG demonstrated a significantly lower rate using APM staple-line reinforcement as compared to oversewing, use of sealants, BPS reinforcement, or no reinforcement. Variation in surgical technique may also contribute to leak rates. Electronic supplementary material The online version of this article (10.1007/s00464-019-06782-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michel Gagner
- Department of Surgery, Hopital du Sacré Coeur, 315 Place D’Youville, Suite 191, Montréal, QC H2Y 0A4 Canada
- Herbert Wertheim School of Medicine, Florida International University, Miami, FL USA
- Westmount Square Surgical Center, Westmount, QC Canada
| | - Paul Kemmeter
- Department of Surgery, Mercy Health Saint Mary’s, 2060 E Paris Ave SE #100, Grand Rapids, MI USA
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Gastropleural Fistula as a Rare Complication of Gastric Sleeve Surgery: A Case Report and Comprehensive Literature Review. Case Rep Surg 2018; 2018:2416915. [PMID: 30671274 PMCID: PMC6317118 DOI: 10.1155/2018/2416915] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/12/2018] [Indexed: 12/12/2022] Open
Abstract
Gastropleural fistula (GPF) is a rare, life-threatening complication of gastric sleeve surgery. GPF is an uncommon differential diagnosis to consider in a patient presenting with a picture of pneumonia. As such, GPF should be suspected in a patient with a history of nonresolving pneumonia who recently underwent gastric sleeve surgery. To the best of our knowledge, only eight cases of gastropleural fistulas after bariatric surgery have been reported in the literature. Herein, we report a case of gastropleural fistula after gastric sleeve surgery and review the pertinent literature. A gastropleural fistula is an exceedingly rare and life-threatening complication postbariatric surgery. Nonsurgical conservative management (total parenteral nutrition, percutaneous drainage, and antibiotics with endoscopic stenting) can be considered.
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Utility of Immediate Postoperative Upper Gastrointestinal Contrast Study in Bariatric Surgery. Obes Surg 2018; 29:1130-1133. [DOI: 10.1007/s11695-018-03639-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Randomized controlled trial of monopolar cautery versus clips for staple line bleeding control in Roux-en-Y gastric bypass. Int J Surg 2018; 58:52-56. [PMID: 30240771 DOI: 10.1016/j.ijsu.2018.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/27/2018] [Accepted: 09/07/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Bleeding from the staple line is a rare but serious problem following bariatric surgery. Staple line bleeding control (SLBC) can be achieved in different ways such as the application of sutures, clips, glue or buttressing materials over the staple line. Cauterization alone is generally not preferred due to concerns about debilitating the staple line. OBJECTIVES The aim of this study was to compare the clip and monopolar cauterization methods for SLBC in laparoscopic Roux-en-Y gastric bypass. SETTING University hospital. METHODS A total of 70 morbidly obese patients were randomized into two groups. Patients with previous upper gastrointestinal surgery, re-do procedures and open surgeries were excluded. Their demographic characteristics, intraoperative and postoperative outcomes were examined. RESULTS A total of 489 SLBC interventions (274 clips and 215 cauterizations) were performed after 280 stapling applications. SLBC intervention number and location, additional trocar requirement, blood loss and operation time were not different between the groups. In the clip group, two patients required monopolar cauterization when clipping failed. No intraabdominal bleeding or gastrointestinal leakage was seen in any group. Postoperative gastrointestinal hemorrhage was seen in three patients, two in the clip group and one in the cautery group. There was no difference between the groups in terms of postoperative pain score, abdominal drainage amount, hemoglobin level alteration, morbidity or length of stay. CONCLUSIONS In laparoscopic Roux-en-Y gastric bypass, monopolar cauterization for SLBC can be used instead of clipping. It appears that monopolar cautery is a safe and effective approach for SLBC in laparoscopic Roux-en-Y gastric bypass.
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Iossa A, Caporilli D, Avallone M, Ciccioriccio MC, Silecchia G. Leak after sleeve gastrectomy: how long do we have to be worried? MINERVA CHIR 2018; 73:522-524. [PMID: 30227703 DOI: 10.23736/s0026-4733.18.07551-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Angelo Iossa
- Department of Medical-Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Centre of Excellence, "La Sapienza" University of Rome, Rome, Italy -
| | - Daniela Caporilli
- Department of Medical-Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Centre of Excellence, "La Sapienza" University of Rome, Rome, Italy
| | - Marcello Avallone
- Department of Medical-Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Centre of Excellence, "La Sapienza" University of Rome, Rome, Italy
| | - Maria C Ciccioriccio
- Department of Medical-Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Centre of Excellence, "La Sapienza" University of Rome, Rome, Italy
| | - Gianfranco Silecchia
- Department of Medical-Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Centre of Excellence, "La Sapienza" University of Rome, Rome, Italy
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Al Lehibi A, Al Balkhi A, Al Mtawa A, Al Otaibi N. Endoscopic biodegradable stents as a rescue treatment in the management of post bariatric surgery leaks: a case series. Endosc Int Open 2018; 6:E722-E726. [PMID: 29868637 PMCID: PMC5979196 DOI: 10.1055/a-0600-9562] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 02/02/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND AIMS Postoperative leak is one of the most feared complications after bariatric surgery. Endoscopic stenting is used to manage leaks by decreasing the gastrointestinal intraluminal pressure. The main advantage of endoscopic management is providing healing while still allowing for oral nutrition. However, limited literature exists on whether biodegradable stents can be used to control leaks when conventional metallic stents fail. METHODS Our series consists of four patients who were found to have a leak as a complication of bariatric surgery. Two patients were initially managed by abdominal/chest drainage, and one required total parenteral nutrition. Conventional endoscopic exclusion techniques with short and long fully covered metallic stents were tried and failed in three of the four patients included in this series. Thus, biodegradable stents were used as a rescue option. RESULTS Biodegradable stents provided immediate improvement for all of the patients, and Gastrografin studies were leak-free 2 days after the procedure. All patients were started on oral feeding and discharged home within 5 - 6 days later. Minimum outpatient follow-up of 8 weeks was achieved with no issues. Follow-up endoscopy was performed 2 - 3 months later in three patients and showed completely resorbed stents. The only drawback was the mucosal reaction to the stent causing dysphagia in two patients, who eventually needed esophageal dilatation. CONCLUSION Biodegradable stents have the potential to provide a reasonable rescue option to manage post bariatric surgery leaks in patients who fail conventional endoscopic exclusion methods. However, data from larger studies are needed to collect information on which theoretical advantages/disadvantages of degradable biomaterials apply to real practice.
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Affiliation(s)
- Abed Al Lehibi
- Gastroenterology and Hepatology Department, King Fahad Medical City, Riyadh, Saudi Arabia,Corresponding author Abed Al Lehibi, MD P.O. Box 59046Riyadh 11525Kingdom of Saudi Arabia+966-11-2889999, ext. 8361
| | - Areej Al Balkhi
- Gastroenterology and Hepatology Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah Al Mtawa
- Gastroenterology and Hepatology Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Nawaf Al Otaibi
- Gastroenterology and Hepatology Department, King Fahad Medical City, Riyadh, Saudi Arabia
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Comparison Between Stable Line Reinforcement by Barbed Suture and Non-reinforcement in Sleeve Gastrectomy: a Randomized Prospective Controlled Study. Obes Surg 2018; 28:2157-2164. [DOI: 10.1007/s11695-018-3175-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Altieri MS, Wright B, Peredo A, Pryor AD. Common weight loss procedures and their complications. Am J Emerg Med 2018; 36:475-479. [DOI: 10.1016/j.ajem.2017.11.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 11/03/2017] [Accepted: 11/20/2017] [Indexed: 01/01/2023] Open
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Abstract
INTRODUCTION Laparoscopic sleeve gastrectomy (LSG) has become one of the most commonly performed bariatric procedures, largely due to several advantages it carries over more complex bariatric procedures. LSG is generally considered a straightforward procedure, but one of the major concerns is a staple line leak. OBJECTIVE The objectives of this study are to evaluate the correlation between surgeon's experience and leak rate and to assess the different risk factors for developing a gastric leak after LSG. SETTING Private hospital, France. METHODS The analysis of a single surgeon's yearly leak rate since the introduction of LSG for possible risk factors was done. RESULTS A total of 2012 LSGs were performed in between September, 2005 and December, 2014. Twenty cases (1 %) of gastric leak were recorded. Of these, 17 patients were women (94.4 %) with a mean age of 39.4 years (range 22-61) and mean body mass index (BMI) 41.2 kg/m(2) (range 34.8-57.1). On a yearly basis, the leak rate was 4.8 % (2006), 5.7 % (2007), 0 (2008), 2.6 % (2009), 2 % (2010), 0.8 % (2011), 0.6 % (2012), 0.2 % (2013), and 0 (2014). In the first 1000 cases (group A), there were 18 cases of gastric leak and in the last 1000 cases, there were 800 with GORE® SEAMGUARD® Bioabsorbable Staple Line Reinforcement (group B) 2 cases of gastric leak (p = 0.009). A revisional LSG, 395 patients after gastric banding and 61 patients re-sleeve gastrectomy, was performed in 456 cases (22.7 %). There were 3 cases of leak (0.65 %). There were two deaths. CONCLUSION LSG can be performed with a low complication rate. This large series of a single surgeon's experience demonstrated that the leak rate after LSG could be significantly decreased over time with changes in techniques.
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