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Hsu JL, Ismail S, Hodges MM, Agala CB, Farrell TM. Bariatric surgery: trends in utilization, complications, conversions and revisions. Surg Endosc 2024; 38:4613-4623. [PMID: 38902405 PMCID: PMC11289040 DOI: 10.1007/s00464-024-10985-7] [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: 04/19/2024] [Accepted: 06/02/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Sleeve gastrectomy (SG) increased in popularity after 2010 but recent data suggest it has concerning rates of gastroesophageal reflux and need for conversions. This study aims to evaluate recent trends in the utilization of bariatric procedures, associated complications, and conversions using an administrative claims database in the United States. METHODS We included adults who had bariatric procedures from 2000 to 2020 with continuous enrollment for at least 6 months in the MarketScan Commercial Claims and Encounters database. Index bariatric procedures and subsequent revisions or conversions were identified using CPT codes. Baseline comorbidities and postoperative complications were identified with ICD-9-CM and ICD-10 codes. Cumulative incidences of complications were estimated at 30-days, 6-months, and 1-year and compared with stabilized inverse probability of treatment weighted Kaplan-Meier analysis. RESULTS We identified 349,411 bariatric procedures and 5521 conversions or revisions. The sampled SG volume appeared to begin declining in 2018 while Roux-en-Y gastric bypass (RYGB) remained steady. Compared to RYGB, SG was associated with lower 1-year incidence [aHR, (95% CIs)] for 30-days readmission [0.65, (0.64-0.68)], dehydration [0.75, (0.73-0.78)], nausea or vomiting [0.70, (0.69-0.72)], dysphagia [0.55, (0.53-0.57)], and gastrointestinal hemorrhage [0.43, (0.40-0.46)]. Compared to RYGB, SG was associated with higher 1-year incidence [aHR, (95% CIs)] of esophagogastroduodenoscopy [1.13, (1.11-1.15)], heartburn [1.38, (1.28-1.49)], gastritis [4.28, (4.14-4.44)], portal vein thrombosis [3.93, (2.82-5.48)], and hernias of all types [1.36, (1.34-1.39)]. There were more conversions from SG to RYGB than re-sleeving procedures. SG had a significantly lower 1-year incidence of other non-revisional surgical interventions when compared to RYGB. CONCLUSIONS The overall volume of bariatric procedures within the claims database appeared to be declining over the last 10 years. The decreasing proportion of SG and the increasing proportion of RYGB suggest the specific complications of SG may be driving this trend. Clearly, RYGB should remain an important tool in the bariatric surgeon's armamentarium.
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Affiliation(s)
- Justin L Hsu
- Department of Surgery, University of Toledo College of Medicine and Life Sciences, Mail Stop 1095, 3000 Arlington Ave, Toledo, OH, 43614, USA.
| | - Sherin Ismail
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Maggie M Hodges
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Chris B Agala
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Timothy M Farrell
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
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El Nakeeb A, Salem A, El Sorogy M, Elrefai M, Rashad AE, Sewefy AM, Kayed T, Mohammed MM, Zaid A, Aldossary HM, Dabobash MD, Sboui K, Attia M. Impact of Helicobacter pylori Status on Postoperative Morbidities After Laparoscopic Sleeve Gastrectomy in an Endemic Region (a Retrospective Multicentric Study). Obes Surg 2024; 34:183-191. [PMID: 37989926 DOI: 10.1007/s11695-023-06961-0] [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: 10/01/2023] [Revised: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE Studies are still ongoing to determine whether Helicobacter pylori (HP) may affect the results of laparoscopic sleeve gastrectomy (LSG). The main research objectives were HP prevalence in patients with severe obesity and the effects of HP status on outcomes. PATIENTS AND METHODS This multicenter retrospective study included patients with severe obesity who had LSG. The patients were grouped into three groups based on the HP status of preoperative endoscopic biopsies and postoperative specimen results: group I (negative HP), group II (eradicated HP), and group III (positive HP). The primary outcome was the overall postoperative morbidities. RESULTS One thousand six hundred fifteen patients who underwent LSG for severe obesity were included in this study. Seven hundred fifty (46.4%) patients had negative HP, and 637 (39.4%) patients had eradicated HP, whereas 228 (14.1%) patients had positive HP. The antral and gastric body wall thickness was significantly noticed with positive HP. The groups had no significant differences regarding postoperative complication frequency, severity, and hospital mortality. The rates of gastric leakage in the three groups do not differ significantly. BMI > 50, gastropexy, gastric thickness, and antral resection were found to be independent risk factors for the occurrence of postoperative complications after LSG. There was no statistical significance as regards postoperative %TWL and %EWL among the three groups. CONCLUSION The early results of LSG do not appear to be impacted by HP's status. The early postoperative course is unaffected by HP eradication anymore. Therefore, routine preoperative HP testing may not be as necessary, and management can be finished after LSG.
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Affiliation(s)
- Ayman El Nakeeb
- Gastroenterology Surgical Center 1 Mansoura University, Mansoura, 35516, Egypt.
- Wadi Aldawaser Armed Forces Hospital, 18511, Wadi Aldawaser, Saudi Arabia.
| | - Ali Salem
- Gastroenterology Surgical Center 1 Mansoura University, Mansoura, 35516, Egypt
| | - Mohamed El Sorogy
- Gastroenterology Surgical Center 1 Mansoura University, Mansoura, 35516, Egypt
| | - Mohamad Elrefai
- Gastroenterology Surgical Center 1 Mansoura University, Mansoura, 35516, Egypt
| | - Aly E Rashad
- Gastroenterology Surgical Center 1 Mansoura University, Mansoura, 35516, Egypt
- Wadi Aldawaser Armed Forces Hospital, 18511, Wadi Aldawaser, Saudi Arabia
| | | | - Taha Kayed
- Minia University Hospital, Minya, 61519, Egypt
| | | | - Ahmed Zaid
- Wadi Aldawaser Armed Forces Hospital, 18511, Wadi Aldawaser, Saudi Arabia
| | | | - Mahmoud D Dabobash
- Wadi Aldawaser Armed Forces Hospital, 18511, Wadi Aldawaser, Saudi Arabia
| | - Kalthoum Sboui
- Wadi Aldawaser Armed Forces Hospital, 18511, Wadi Aldawaser, Saudi Arabia
| | - Mohamed Attia
- Gastroenterology Surgical Center 1 Mansoura University, Mansoura, 35516, Egypt
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Noel P, Olmi S, Gentileschi P, Caiazzo R, Marciniak C, Pintado DGM, Ungson G, Alarcon V, Carandina S, Manos T, Shamoun JM, Zundel N, Lutfi RE, Ponce J, Nedelcu M. Classification of Slippage Following Laparoscopic BariClip Gastroplasty. Obes Surg 2023; 33:3317-3322. [PMID: 37608121 DOI: 10.1007/s11695-023-06780-3] [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: 04/09/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION Laparoscopic BariClip gastroplasty (LBCG) is a new reversible gastric sleeve-like procedure without gastrectomy proposed to minimize the risk of severe complications. Still one of the possible complications described with LBCG is slippage. The purpose of the current manuscript is to analyze different cases of slippage and propose a classification of this complication. METHODS A number of 381 patients who underwent LBCG in 8 different centers were analyzed concerning the risk of slippage. All cases with documented slippage were carefully reviewed in terms of patients' symptomatology (presence of satiety, vomiting), history of weight loss, radiological data, and management of their slippage. A new classification was proposed depending on the anatomy, the symptomatology, and the time of occurrence. RESULTS We have identified a total of 17 cases (4.46%) of slippage following LBCG. In 11 patients, the slippage was symptomatic with repetitive vomiting and nausea, and in the remaining 6 patients, the slippage was identified by radiological studies for insufficient weight loss, weight regain, or routine radiological follow-up. Depending on the interval time, the slippage was classified as either immediate (in first 7 days) in 6 cases, early (in less than 90 days) in 4 cases, and late (after 3 months) in 7 cases. Evaluation of the radiological studies in these cases identified the following: anterosuperior displacement (type A) in 9 cases, posteroinferior displacement (type B) in 6 cases (one case after 3 months), and lateral displacement (type C) in the remaining 2 cases. The management of the slippage consisted of BariClip removal in 7 cases, repositioning in 5 cases, and conservative treatment in the remaining 5 cases. All patients with conservative treatment were recorded at the beginning of the experience. CONCLUSIONS Slippage is a possible complication after LBCG. This classification of the different types of slippage can benefit the surgeon in the management and treatment of this complication of LBCG.
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Affiliation(s)
- Patrick Noel
- Emirates Specialty Hospital, Dubai, UAE
- ELSAN, Clinique Bouchard, Marseille, France
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obésité, Toulon, France
| | - Stefano Olmi
- Policlinico San Marco, Rio Isolo, Zingonia, Italy
| | | | - Robert Caiazzo
- Endocrine and General Surgery Department, Lille University Hospital, Lille, France
| | - Camille Marciniak
- Endocrine and General Surgery Department, Lille University Hospital, Lille, France
| | | | | | | | - Sergio Carandina
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obésité, Toulon, France
| | | | - John M Shamoun
- Hoag Memorial Hospital Presbyterian, Newport Beach, CA, USA
| | - Natan Zundel
- University at Buffalo, NY, Jackson North Medical Center, Miami, USA
| | | | | | - Marius Nedelcu
- ELSAN, Clinique Bouchard, Marseille, France.
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obésité, Toulon, France.
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Ortiz Gómez E, Vera Macías J, Meza Jasso MA, Guzmán Barba JA, Esparza Estrada I. Uncommon Complication of a Biliary Leak After Adjustable Gastric Band Removal: A Case Report. Cureus 2023; 15:e46856. [PMID: 37954734 PMCID: PMC10637720 DOI: 10.7759/cureus.46856] [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] [Accepted: 10/10/2023] [Indexed: 11/14/2023] Open
Abstract
In the context of adjustable gastric band (AGB) placements and the prevalent issue of weight regain with associated complications, revision surgery for gastric bands becomes imperative. Such revisions may encompass band removal or conversion to bariatric procedures, often accompanied by an escalated risk profile, potentially contributing to a 20% morbidity rate. Laparoscopic sleeve gastrectomy (LSG) has gained prominence due to its technical simplicity, effectiveness in weight loss, and lower complication rates. Specific cases involving LSG post-AGB complications are associated with staple line disruptions and leaks. This case report describes a rare complication in a 59-year-old patient following AGB removal and subsequent laparoscopic sleeve gastrectomy. The complication emerged six hours after the surgery, with approximately 400 cc of bile material reported in the drainage. A laparoscopic reintervention was conducted, revealing bile leakage from the second Couinaud hepatic segment. Successful management of the leakage was achieved through simple hepatic suturing using non-absorbable monofilament. Within 24 hours, no further leakage occurred, and the patient was discharged without additional complications. Our case also demonstrates how complex it can be to switch between different medical procedures, and it emphasizes the need for careful planning and precise surgery in the evolving world of bariatric medicine. It is worth noting that there is a dearth of literature addressing this specific complication. Consequently, this study has the potential to provide valuable insights for surgeons who may encounter a similar scenario in their clinical practice.
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Kouladouros K. Applications of endoscopic vacuum therapy in the upper gastrointestinal tract. World J Gastrointest Endosc 2023; 15:420-433. [PMID: 37397978 PMCID: PMC10308278 DOI: 10.4253/wjge.v15.i6.420] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/15/2023] [Accepted: 06/02/2023] [Indexed: 06/14/2023] Open
Abstract
Endoscopic vacuum therapy (EVT) is an increasingly popular treatment option for wall defects in the upper gastrointestinal tract. After its initial description for the treatment of anastomotic leaks after esophageal and gastric surgery, it was also implemented for a wide range of defects, including acute perforations, duodenal lesions, and postbariatric complications. Apart from the initially proposed handmade sponge inserted using the “piggyback” technique, further devices were used, such as the commercially available EsoSponge and VAC-Stent as well as open-pore film drainage. The reported pressure settings and intervals between the subsequent endoscopic procedures vary greatly, but all available evidence highlights the efficacy of EVT, with high success rates and low morbidity and mortality, so that in many centers it is considered to be a first-line treatment, especially for anastomotic leaks.
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Affiliation(s)
- Konstantinos Kouladouros
- Central Interdisciplinary Endoscopy, Surgical Clinic, Mannheim University Hospital, University of Heidelberg, Mannheim 68167, Baden-Wuerttemberg, Germany
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6
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Jing W, Huang Y, Feng J, Li H, Yu X, Zhao B, Wei P. The clinical effectiveness of staple line reinforcement with different matrix used in surgery. Front Bioeng Biotechnol 2023; 11:1178619. [PMID: 37351469 PMCID: PMC10282759 DOI: 10.3389/fbioe.2023.1178619] [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: 03/03/2023] [Accepted: 05/24/2023] [Indexed: 06/24/2023] Open
Abstract
Staplers are widely used in clinics; however, complications such as bleeding and leakage remain a challenge for surgeons. To tackle this issue, buttress materials are recommended to reinforce the staple line. This Review provides a systematic summary of the characteristics and applications of the buttress materials. First, the physical and chemical properties of synthetic polymer materials and extracellular matrix used for the buttress materials are introduced, as well as their pros and cons in clinical applications. Second, we review the clinical effects of reinforcement mesh in pneumonectomy, sleeve gastrectomy, pancreatectomy, and colorectal resection. Based on the analysis of numerous research data, we believe that buttress materials play a crucial role in increasing staple line strength and reducing the probability of complications, such as bleeding and leakage. However, considering the requirements of bioactivity, degradability, and biosafety, non-crosslinked small intestinal submucosa (SIS) matrix material is the preferred candidate. It has high research and application value, but further studies are required to confirm this. The aim of this Review is to provide comprehensive guidance on the selection of materials for staple line reinforcement.
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Affiliation(s)
| | | | | | | | | | - Bo Zhao
- *Correspondence: Bo Zhao, ; Pengfei Wei,
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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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Nedelcu M, Carandina S, Noel P, Mercoli HA, Danan M, Zulian V, Nedelcu A, Vilallonga R. The Utility of Video Recording in Assessing Bariatric Surgery Complications. J Clin Med 2022; 11:jcm11195573. [PMID: 36233435 PMCID: PMC9572461 DOI: 10.3390/jcm11195573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/28/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Recording every procedure could diminish the postoperative complication rates in bariatric surgery. The aim of our study was to evaluate the correlation between recording every bariatric surgery and their postoperative analysis in relation to the early or late postoperative complications. Methods: Seven hundred fifteen patients who underwent a bariatric procedure between January 2018 and December 2019 were included in a retrospective analysis. There were: 589 laparoscopic sleeve gastrectomies (LSGs); 110 Roux-en-Y bypasses (RYGBs) and 16 gastric bands (LAGBs). The video recording was systematically used, and all patients were enrolled in the IFSO registry. Results: There were 15 patients (2.1%) with surgical postoperative complications: 5 leaks, 8 hemorrhages and 2 stenosis. Most complications were consequent to LSG, except for two, which occurred after RYGB. In four cases a site of active bleeding was identified. After reviewing the video, in three cases the site was correlated with an event which occurred during the initial procedure. Three out of five cases of leak following sleeve were treated purely endoscopically, and no potential correlated mechanism was identified. Two other possible benefits were observed: a better evaluation of the gastric pouch for the treatment of the ulcer post bypass and the review of one per operative incident. Two negative diagnostic laparoscopies were performed. The benefit of the systematic video recording was singled out in eight cases. All the other cases were completed by laparoscopy with no conversion. Conclusion: To record every bariatric procedure could help in understanding the mechanism of certain complications, especially when the analysis is performed within the team. Still, recording the procedure did not prevent the negative diagnostic laparoscopy, but it could play a significant role for the medico-legal aspect in the future.
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Affiliation(s)
- Marius Nedelcu
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Obesite, 83000 Toulon, France
- ELSAN, Clinique Bouchard, 13000 Marseille, France
- Correspondence: ; Tel.: +33-695950965
| | - Sergio Carandina
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Obesite, 83000 Toulon, France
| | - Patrick Noel
- ELSAN, Clinique Bouchard, 13000 Marseille, France
- Emirates Specialty Hospital, Dubai 505240, United Arab Emirates
| | | | - Marc Danan
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Obesite, 83000 Toulon, France
| | - Viola Zulian
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Obesite, 83000 Toulon, France
| | - Anamaria Nedelcu
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Obesite, 83000 Toulon, France
| | - Ramon Vilallonga
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Obesite, 83000 Toulon, France
- Universitat Autònoma de Barcelona, 08028 Barcelona, Spain
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Hospital Vall d’Hebron, 08023 Barcelona, Spain
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El Nakeeb A, Aldossary H, Zaid A, El Sorogy M, Elrefai M, Attia M, Sewefy AM, Kayed T, Aldawsari MAS, Al Dossari HM, Mohammed MM. Prevalence, Predictors, and Management of Gastroesophageal Reflux Disease After Laparoscopic Sleeve Gastrectomy: a Multicenter Cohort Study. Obes Surg 2022; 32:3541-3550. [PMID: 36087223 DOI: 10.1007/s11695-022-06264-w] [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: 06/13/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND One of the most popular bariatric procedures is laparoscopic sleeve gastrectomy (LSG), which can either cause or worsen gastroesophageal reflux disease (GERD). Therefore, the goal of this study was to examine the prevalence, predictors, and management of GERD symptoms after LSG. MATERIALS AND METHODS From January 2017 to January 2022, we looked at patients who had a primary LSG and developed GERD. Before LSG, all patients underwent a barium meal and upper endoscopy. After LSG, barium meal, endoscopy, esophageal manometry, and 24-h pH measurements were performed for selected patients. The diagnosis of GERD is based on the GERD-HRQL questionnaire and upper endoscopy. RESULTS The study included 1537 patients (62.5% women and 37.5% men) with a mean age of 34.4 years. The mean % TWL was 40.7% during a mean follow-up period of 15.9 months. A total of 379 patients (24.7%) experienced postoperative GERD, of whom 328 (21.3%) had postoperative de novo GERD symptoms, 25 (1.6%) had worsened preoperative GERD, and 26 (1.7%) had the same preoperative GERD symptoms. Antral preservation and gastropexy were protective factors against the development of GERD after LSG. LSG was converted to LRYGB in 15.8% of the patients with GERD. The response to medical treatment was observed in 300 (79.2%) patients with GERD. CONCLUSION Post-LSG GERD presented in 379 patients (24.7%). Antral preservation and gastropexy were protective factors for the development of postoperative GERD after LSG. Medical treatment was the main line of treatment for GERD. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT05416645.
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Affiliation(s)
- Ayman El Nakeeb
- Gastrointestinal Surgical Center, and Mansoura University Hospital, Mansoura University, Mansoura, 35516, Egypt. .,Wadi Al Dawasir Armed Forces Hospital, Wadi Al Dawasir, Kingdom of Saudi Arabia.
| | - Hassan Aldossary
- Wadi Al Dawasir Armed Forces Hospital, Wadi Al Dawasir, Kingdom of Saudi Arabia
| | - Ahmed Zaid
- Wadi Al Dawasir Armed Forces Hospital, Wadi Al Dawasir, Kingdom of Saudi Arabia
| | - Mohamed El Sorogy
- Gastrointestinal Surgical Center, and Mansoura University Hospital, Mansoura University, Mansoura, 35516, Egypt
| | - Mohamad Elrefai
- Gastrointestinal Surgical Center, and Mansoura University Hospital, Mansoura University, Mansoura, 35516, Egypt
| | - Mohamed Attia
- Gastrointestinal Surgical Center, and Mansoura University Hospital, Mansoura University, Mansoura, 35516, Egypt
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Iannelli A, Chierici A, Castaldi A, Drai C, Schneck AS. Bioabsorbable Glycolide Copolymer is Effective in Reducing Staple Line Bleeding in Sleeve Gastrectomy. Obes Surg 2022; 32:2605-2610. [PMID: 35696051 DOI: 10.1007/s11695-022-06152-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Postoperative bleeding from the staple line after sleeve gastrectomy occurs in 2-8% of patients and it is associated with increased length and cost of hospitalization and may demand reoperation to gain hemostasis. Reinforced staplers are used by bariatric surgeons to reduce the incidence of postoperative leak but can have a role in avoiding bleeding. The aim of this study is to analyze the effects of reinforcement on the whole gastric staple line during sleeve gastrectomy on postoperative bleeding. METHODS Four hundred forty-eight consecutive patients undergoing sleeve gastrectomy from November 2012 to April 2019 were divided into two groups. In the Top-only group only the top staple shot was realized with reinforced material (GORE® SEAMGUARD®) while in the Bottom-to-Top group, patients received full staple line reinforcement. Statistical analysis focused on postoperative leak and bleeding, and length of stay; a propensity score matching analysis was performed to reduce between-group characteristics imbalance. RESULTS One hundred forty-five (Top-only) and 303 (Bottom-to-Top) patients were included. Four (2.8%) patients in the Top-only group and none in the Bottom-to-Top group experienced severe bleeding (p = 0.004); the difference was still significant after propensity score matching. Length of stay was significantly shorter for the Bottom-to-Top group before and after propensity score matching (4 vs. 5 days, p < 0.001). CONCLUSIONS Staple line buttressing reduces the incidence of severe postoperative bleeding when performed on the whole staple line, and it is associated with a shorter hospitalization.
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Affiliation(s)
- Antonio Iannelli
- Université Côte d'Azur, Nice, France.
- Digestive Surgery and Liver Transplantation Unit, Centre Hospitalier Universitaire de Nice, Archet 2 Hospital, 151 Route Saint Antoine de Ginestière, BP 3079, Nice, France.
- Inserm, U1065, Team 8 "Hepatic Complications of Obesity and Alcohol", Nice, France.
| | - Andrea Chierici
- Service de Chirurgie Digestive, Centre Hospitalier d'Antibes Juan-Les-Pins, 107, av. de Nice, 06600, Antibes, France
| | - Antonio Castaldi
- Digestive Surgery and Liver Transplantation Unit, Centre Hospitalier Universitaire de Nice, Archet 2 Hospital, 151 Route Saint Antoine de Ginestière, BP 3079, Nice, France
| | - Céline Drai
- Université Côte d'Azur, Nice, France
- Digestive Surgery and Liver Transplantation Unit, Centre Hospitalier Universitaire de Nice, Archet 2 Hospital, 151 Route Saint Antoine de Ginestière, BP 3079, Nice, France
| | - Anne-Sophie Schneck
- Digestive Surgery Unit, Centre Hospitalier Universitaire de Guadeloupe, 97159, Pointe à Pitre, Guadeloupe
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11
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El Nakeeb A, El Sorogy M, Hamed H, Elrefai M, Attia M, Emile SH, Abdallah E, Khafagy W, Kayed T, Sewefy AM, AlMalki A, Alqahtani AN, Ghazwani M, Al-Asmary M, Mohammed MM. Effect of Altitude Level on Surgical Outcomes of Laparoscopic Sleeve Gastrectomy for Patients With Morbid Obesity: A Multicentre Prospective Study. Surg Laparosc Endosc Percutan Tech 2021; 32:176-181. [PMID: 34966149 DOI: 10.1097/sle.0000000000001030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/05/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND This study aimed to evaluate the impact of altitude level on surgical outcomes of laparoscopic sleeve gastrectomy (LSG) for patients with morbid obesity. METHODS At the normal altitude level, 808 patients underwent LSG, and 467 patients underwent LSG in high-altitude regions. The primary outcome was evaluated based on the postoperative morbidity rate. Secondary outcomes were evaluated based on operating time, mortality, hospital stay, percentage of total weight loss (TWL), and comorbidities improvement. RESULTS No significant differences were noted in-hospital stay, time to start oral intake, gastric leakage, overall complications, and hospital mortality between the 2 groups. Deep vein thrombosis, pulmonary embolism, and mesenteric vascular occlusion were significantly higher in high altitude [11 (1.3%) vs. 14 (3%), P=0.04; 8 (0.7%) vs. 11 (2.4%), P=0.01; 4 (0.5%) vs. 8 (1.7%), P=0.03, respectively]. Patients with normal altitude recorded a better %TWL than those at high altitude after 12 months (41±9 vs. 39±9.6, P=0.002) and after 24 months (41±8 vs. 40±9, P=0.009). In both groups, a significant improvement was noted in comorbidity after LSG. CONCLUSION The %TWL significantly achieved with LSG in normal and high altitudes. After 12 and 24 months, the %TWL is significantly higher with LSG at normal altitudes. High altitude is associated with a high incidence of deep vein thrombosis, pulmonary embolism, and superior mesenteric vascular occlusion with LSG.
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Affiliation(s)
| | | | - Hosam Hamed
- Gastroenterology Surgical Center, Mansoura University
| | | | - Mohamed Attia
- Gastroenterology Surgical Center, Mansoura University
| | | | - Emad Abdallah
- Surgical Department, Mansoura University Hospital, Mansoura
| | - Wael Khafagy
- Surgical Department, Mansoura University Hospital, Mansoura
| | - Taha Kayed
- Minia University Hospital, Surgical Department, Minia, Egypt
| | - Alaa M Sewefy
- Minia University Hospital, Surgical Department, Minia, Egypt
| | - Ahmad AlMalki
- Aseer Central Hospital, Aseer Region, Kingdom of Saudi Arabia
| | - Ali N Alqahtani
- Aseer Central Hospital, Aseer Region, Kingdom of Saudi Arabia
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12
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Wichmann D, Scheble V, Fusco S, Schweizer U, Hönes F, Klingert W, Königsrainer A, Archid R. Role of Rendezvous-Procedure in the Treatment of Complications after Laparoscopic Sleeve Gastrectomy. J Clin Med 2021; 10:jcm10235670. [PMID: 34884372 PMCID: PMC8658356 DOI: 10.3390/jcm10235670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/26/2021] [Accepted: 11/30/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction: Laparoscopic sleeve gastrectomy is one of the most commonly performed bariatric procedures worldwide with good results, high patient acceptance, and low complication rates. The most relevant perioperative complication is the staple line leak. For the treatment of this complication, endoscopic negative pressure therapy has proven particularly effective. The correct time to start endoscopic negative pressure therapy has not been the subject of studies to date. Methods: Twelve patients were included in this retrospective data analysis over three years. Endoscopic negative pressure therapy was carried out using innovative open pore suction devices. Patients were treated with simultaneous surgery and endoscopy, so called rendezvous-procedure (Group A) or solely endoscopically, or in sequence surgically and endoscopically (Group B). Therapy data of the procedures and outcome measures, including duration of therapy, therapy success, and change of treatment strategy, were collected and analysed. Results: In each group, six patients were treated (mean age 52.96 years, 4 males, 8 females). Poor initial clinical situation, time span of endoscopic negative pressure therapy (Group A 31 days vs. Group B 18 days), and mean length of hospital stay (Group A 39.5 days vs. Group B 20.17 days) were higher in patients with rendezvous procedures. One patient in Group B died during the observation time. Discussion: Rendezvous procedures for patients with staple line leaks after sleeve gastrectomy is indicated for serious ill patients with perigastric abscesses and in need of laparoscopic lavage. The one-stage complication management with the rendezvous procedure seems not to result in an obvious advantage in the further outcome in patients with staple line leaks after laparoscopic sleeve gastrectomy.
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Affiliation(s)
- Dörte Wichmann
- Department of General and Transplant Surgery, University Hospital of Tübingen, 72076 Tübingen, Germany; (D.W.); (U.S.); (F.H.); (W.K.); (A.K.); (R.A.)
| | - Veit Scheble
- Department of Internal Medicine 1, Division for Gastroenterology, Hepatology, Infectiology, Gastrointestinal Oncology and Geriatrics, University Hospital of Tübingen, 72076 Tübingen, Germany;
| | - Stefano Fusco
- Department of Internal Medicine 1, Division for Gastroenterology, Hepatology, Infectiology, Gastrointestinal Oncology and Geriatrics, University Hospital of Tübingen, 72076 Tübingen, Germany;
- Correspondence:
| | - Ulrich Schweizer
- Department of General and Transplant Surgery, University Hospital of Tübingen, 72076 Tübingen, Germany; (D.W.); (U.S.); (F.H.); (W.K.); (A.K.); (R.A.)
| | - Felix Hönes
- Department of General and Transplant Surgery, University Hospital of Tübingen, 72076 Tübingen, Germany; (D.W.); (U.S.); (F.H.); (W.K.); (A.K.); (R.A.)
| | - Wilfried Klingert
- Department of General and Transplant Surgery, University Hospital of Tübingen, 72076 Tübingen, Germany; (D.W.); (U.S.); (F.H.); (W.K.); (A.K.); (R.A.)
| | - Alfred Königsrainer
- Department of General and Transplant Surgery, University Hospital of Tübingen, 72076 Tübingen, Germany; (D.W.); (U.S.); (F.H.); (W.K.); (A.K.); (R.A.)
| | - Rami Archid
- Department of General and Transplant Surgery, University Hospital of Tübingen, 72076 Tübingen, Germany; (D.W.); (U.S.); (F.H.); (W.K.); (A.K.); (R.A.)
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13
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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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14
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Chang PC, Chen KH, Jhou HJ, Chen PH, Huang CK, Lee CH, Chang TW. Promising effects of 33 to 36 Fr. bougie calibration for laparoscopic sleeve gastrectomy: a systematic review and network meta-analysis. Sci Rep 2021; 11:15217. [PMID: 34312476 PMCID: PMC8313581 DOI: 10.1038/s41598-021-94716-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/15/2021] [Indexed: 12/18/2022] Open
Abstract
The standard size of bougie for laparoscopic sleeve gastrectomy (LSG) is not yet established. Therefore, a systematic review and network meta-analysis were conducted to assess the weight loss effects and associated complications of LSG for patients with morbid obesity, based on different bougie sizes. A total of 15 studies were reviewed in this systemic review and network meta-analysis (2,848 participants), including RCTs and retrospective studies in PubMed, and Embase until September 1, 2020. The effectiveness of different bougie calibration sizes was assessed based on excess weight loss (EWL), total complications, and staple line leak. Within this network meta-analysis, S-sized (≤ 32 Fr.) and M-sized (33–36 Fr.) bougies had similar effects and were associated with the highest EWL improvement among all different bougie sizes (S-sized: standardized mean difference [SMD], 10.52; 95% confidence interval [CI] − 5.59 to − 26.63, surface under the cumulative ranking curve [SUCRA], 0.78; and M-sized: SMD, 10.16; 95% CI − 3.04–23.37; SUCRA, 0.75). M-sized bougie was associated with the lowest incidence of total complications (M-sized: odds ratio, 0.43; 95% CI, 0.16–1.11; SUCRA, 0.92). Based on our network meta-analysis, using M-sized bougie (33–36 Fr.) is an optimal choice to balance the effectiveness and perioperative safety of LSG in the clinical practice.
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Affiliation(s)
- Po-Chih Chang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan.,Weight Management Center, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan.,Ph.D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.,Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Kai-Hua Chen
- Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung City, 80756, Taiwan
| | - Hong-Jie Jhou
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan.,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Huang Chen
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Chih-Kun Huang
- Body Science and Metabolic Disorders International Medical Center, China Medical University Hospital, Taichung City, Taiwan
| | - Cho-Hao Lee
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ting-Wei Chang
- Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung City, 80756, Taiwan.
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15
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Patrick Noel, FACS, FASMBS, Mediclinic Middle East, Dubai. Obes Surg 2021; 31:2357-2358. [PMID: 33880745 DOI: 10.1007/s11695-021-05425-7] [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]
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16
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Abstract
PURPOSE Laparoscopic sleeve gastrectomy (LSG) is estimated to be its most severe complication. An aggressive management with surgical reconstructive procedures can be proposed in patients in whom all the conservative endoscopic techniques fail. The purpose of the present study was to report our experience with Roux-en-Y gastric bypass (RYGBP) as treatment for the chronic leak after LSG. METHODS Between January 2013 and July 2019, 17 consecutive patients underwent RYGBP for the treatment of chronic leak after LSG. The initial intervention, the endoscopic approach and the definitive surgical repair were carefully reviewed. RESULTS Seventeen patients (13 women) with a median age of 39 years (24-67) with a median body mass index (BMI) of 40 kg/m2 (30-52) underwent RYGBP for persistent fistula. Sixteen patients had their early LSG performed in another hospital. Eleven patients had an initial endoscopic treatment by pigtail drains following laparoscopic drainage and 6 other patients had the endoscopic stent as the first-choice line treatment. The overall average fistula diagnosis was done at 7.7 months (2-49 months) for 12 patients. For the rest of five patients, the procedure was performed almost in the acute setting (< 30 days). All procedures were performed by laparotomy but one. Five patients had a gastrojejunal anastomosis leak diagnosed by salivary flow in the drainage, but all patients were treated conservatively. No post-operative mortality was recorded. CONCLUSIONS Surgery should be considered in case of failure of the endoscopic treatment of chronic leak after LSG. Further research is needed to clearly identify the appropriate treatment, but in our experience, RYGBP approach including the leak site offers a low morbidity rate.
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17
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Petrucciani N, Etienne JH, Sebastianelli L, Iannelli A. Roux-en-Y gastric bypass as revisional surgery. Minerva Surg 2021; 76:8-16. [PMID: 33754587 DOI: 10.23736/s2724-5691.20.08493-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Roux-en-Y gastric bypass (RYGB) is a worldwide-performed procedure as primary surgery, and as conversional procedure after complications and/or failure of other bariatric procedures. RYGB can be performed as revisional surgery after adjustable gastric banding, vertical banded gastroplasty, sleeve gastrectomy and one anastomosis gastric bypass. Each of these revisional procedures may be technically challenging, and accurate preoperative work-up and operative planning is required. If correctly performed, RYGB as revisional procedure is associated with satisfying outcomes and is indicated in the treatment of insufficient weight loss and postoperative complications of a primary bariatric procedure - such as chronic leak or gastroesophageal reflux after sleeve gastrectomy. The present article analyzes the most important indications, technical points and tips and tricks to safely perform RYGB as a secondary procedure.
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Affiliation(s)
- Niccolò Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St. Andrea Hospital, Sapienza University, Rome, Italy
| | - Jean H Etienne
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St. Andrea Hospital, Sapienza University, Rome, Italy.,Université Côte d'Azur, Nice, France
| | - Lionel Sebastianelli
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St. Andrea Hospital, Sapienza University, Rome, Italy.,Université Côte d'Azur, Nice, France
| | - Antonio Iannelli
- Université Côte d'Azur, Nice, France - .,Unit of Digestive Surgery and Liver Transplantation, University Hospital of Nice, Nice, France.,Inserm U1065, Nice, France
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18
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Donatelli G, Manos T, Noel P, Dumont JL, Nedelcu A, Nedelcu M. Aortic injuries following stents in bariatric surgery: our experience. Surg Obes Relat Dis 2021; 17:340-344. [DOI: 10.1016/j.soard.2020.09.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/26/2020] [Accepted: 09/14/2020] [Indexed: 12/26/2022]
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19
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Nedelcu M, Manos T, Noel P, Gagner M, Palermo M, Danan M, Nedelcu A, Vilallonga R. Aortic Injuries Following Stent Deployments in Bariatric Surgery-Review of Literature. J Laparoendosc Adv Surg Tech A 2020; 31:171-175. [PMID: 33351718 DOI: 10.1089/lap.2020.0731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction: Consecutive to an increase in the number of bariatric surgeries worldwide, the number of articles reporting complications have also increased. The most dreadful bariatric complication is represented by the leak, and the endoscopic stent is still the standard treatment for some bariatric teams despite the poor quality of life and associated complications. The purpose of this review was to identify the very rare cases of aortic injuries associated with stent use in bariatric surgery. Methods: Aortic injuries related to stent use was the main criteria to summarize the literature by a careful assessment of PubMed/MEDLINE databases. Leak characteristics, primary endoscopic treatment, and the outcome of endoscopic complication were retrieved and categorized from each eligible article. Results: Thirty-five articles were selected for analysis. After abstract analysis, 22 studies were excluded, and 13 articles were reviewed in full-text version. Four articles were confirmed with aortic injury following stent use for complications after different bariatric procedures. These contained one retrospective case series and three retrospective case reports. There were 4 patients involved with complications following bariatric surgery: Roux-en-Y Gastric Bypass-3 cases and laparoscopic sleeve gastrectomy-1 case. The reported mortality of the aorto-esophageal fistula was 50%. Conclusions: Using stents in the treatment of leaks following bariatric surgery could be an efficient treatment, despite the poor quality of life and the stent migration. Even though it is rare, the aortic injury is a dreaded complication related to stent use and associated with high mortality rates.
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Affiliation(s)
- Marius Nedelcu
- Bariatric Unit, ELSAN, Clinique Bouchard, Marseille, France.,Bariatric Unit, ELSAN, Clinique St-Michel, Toulon, France
| | - Thierry Manos
- Bariatric Unit, ELSAN, Clinique Bouchard, Marseille, France
| | - Patrick Noel
- Bariatric Unit, ELSAN, Clinique Bouchard, Marseille, France
| | - Michel Gagner
- Bariatric Unit, Sacre Coeur Hospital, Montreal, Canada
| | - Mariano Palermo
- Division of Bariatric Surgery of DIAGNOMED, Affiliated Institution of the University of Buenos Aires, Buenos Aires, Argentina
| | - Marc Danan
- Bariatric Unit, ELSAN, Clinique St-Michel, Toulon, France
| | | | - Ramon Vilallonga
- Bariatric Unit, ELSAN, Clinique St-Michel, Toulon, France.,Universitat Autònoma de Barcelona, Barcelona, Spain.,Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Hospital Vall d'Hebron, Barcelona, Spain
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20
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Taleb S, Nedelcu M, Skalli M, Loureiro M, Nedelcu A, Nocca D. The evolution of surgical treatment for chronic leak following sleeve. Surg Obes Relat Dis 2020; 17:278-283. [PMID: 33218903 DOI: 10.1016/j.soard.2020.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/15/2020] [Accepted: 10/02/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Leak is estimated to be the most severe complication of laparoscopic sleeve gastrectomy (LSG), with sporadic failure of endoscopic techniques. In such cases, an aggressive management with surgical reconstructive procedures can be proposed to patients in whom all the conservative endoscopic techniques failed. OBJECTIVES The purpose of the present study was to report our experience with surgical approach for the treatment of chronic leak after LSG. SETTING University hospital, France. METHODS Between January 2013-December 2019, 21 consecutive patients underwent reconstructive surgery for the treatment of chronic leak after LSG. The initial intervention, the endoscopic approach, and the definitive surgical repair were carefully reviewed. RESULTS Twenty-one patients (17 women) with a mean (standard deviation [SD]) age of 42.7 years (9.81) and a mean (SD) body mass index (BMI) of 27.3 (5.2) kg/m2 underwent reconstructive surgery for persistent fistula. Seventeen patients (81%) had their early LSG performed in another hospital. Endoscopic treatment was represented by the pigtail drain or stent in 9 cases each, ovesco in 8 cases, and glue for 2 patients. The reconstructive surgery was performed within 6 months in 8 cases; between 6-12 months in 6 cases; between 1-3 years in 4 cases, and >3 years in 3 cases. There were 14 fistulo-jejunostomy (66.7%), 5 Roux-en-Y gastric bypass (23.8%), and 2 total gastrectomies (9.5%). The operative time was between 99 minutes and 5.5 hours (mean = 216.2, median = 225 min). The hospital stay ranged from 5-30 days (mean = 12.67, median = 11 d) and the surgical reintervention rate was 23.8% (5/21 patients), including 1 case of recurrent hemorrhage requiring 3 surgical operations over 1 month of postoperative follow-up. No postoperative mortality was recorded. CONCLUSIONS Surgery should be considered in case of failure of the endoscopic treatment of chronic leak after LSG. Further research is needed to clearly identify the appropriate treatment, but in our experience the fistulo-jejunostomy approach shows a low morbidity rate. (Surg Obes Relat Dis 2020;17:278-283.) © 2020 American Society for Metabolic and Bariatric Surgery. All rights reserved.
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Affiliation(s)
| | - Marius Nedelcu
- ELSAN, Clinique Bouchard, Marseille, France; ELSAN, Clinique Saint Michel, Toulon, France.
| | | | - Marcelo Loureiro
- CHU de Montpellier, Montpellier, France; University Montpellier 1, Montpellier, France; Universidade Positivo, Curitiba, Brazil
| | | | - David Nocca
- CHU de Montpellier, Montpellier, France; University Montpellier 1, Montpellier, France
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21
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Noel P, Nedelcu M, Manos T, Nedelcu A. Comment on: Laparoscopic revision to total gastrectomy or fistulo-jejunostomy as a definitive procedure for chronic gastric fistula after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2020; 16:1900-1901. [PMID: 32928680 DOI: 10.1016/j.soard.2020.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Patrick Noel
- Emirates Specialty Hospital, Dubai, United Arab Emirates; ELSAN, Clinique Bouchard, Marseille, France
| | - Marius Nedelcu
- ELSAN, Clinique Bouchard, Marseille, France; ELSAN, Centre Chirurgical de l'Obesite, Clinique Saint Michel, Toulon, France
| | | | - Anamaria Nedelcu
- ELSAN, Centre Chirurgical de l'Obesite, Clinique Saint Michel, Toulon, France
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22
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The Impact of Staple Line Reinforcement Utilization on Bleeding and Leak Rates Following Sleeve Gastrectomy for Severe Obesity: a Propensity and Case-Control Matched Analysis. Obes Surg 2020; 29:2449-2463. [PMID: 30989567 DOI: 10.1007/s11695-019-03883-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Staple line reinforcement (SLR) is a commonly used technique during laparoscopic sleeve gastrectomy (SG) for severe obesity. There remains controversy over the potential benefit or risk associated with SLR. There are currently no consensus recommendations about SLR use. Its use is surgeon-dependent and remains controversial. STUDY AIM To determine the impact of staple line reinforcement on staple line leak and bleeding rates after sleeve gastrectomy. METHODS Using the Metabolic and Bariatric Surgery Quality Improvement Program Participant User File (MBSQIP-PUF) database, we identified patients who had a SG in 2015 and 2016. SLR utilization status was used to create two cohorts. An unmatched cohort analysis was performed, and the outcomes were compared. A propensity score and case-control matched cohort analysis were then performed, and the outcomes were compared. Statistical analysis was performed with SPSS and SAS. RESULTS Of the 189,173 SG cases identified, SLR utilization was noted in 127,521 (67.4%). In the unmatched analysis, bleeding and reoperation were significantly higher in the cohort without SLR utilization. In both propensity score and case-control matched analysis, bleeding and reoperation remained significantly higher in the cohort without SLR utilization. There was no difference in mortality and staple line leak rates between the cohorts. CONCLUSIONS SLR significantly reduces bleeding and reoperation rates following SG and has no deleterious impact on staple line leak rate. While further prospective studies factoring in the SLR method and staple characteristics are needed, this large database analysis supports the use of routine SLR during SG to reduce the risk of perioperative bleeding and reoperation.
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23
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Archid R, Wichmann D, Klingert W, Nadiradze G, Hönes F, Archid N, Othman AE, Ahmad SJS, Königsrainer A, Lange J. Endoscopic Vacuum Therapy for Staple Line Leaks after Sleeve Gastrectomy. Obes Surg 2019; 30:1310-1315. [DOI: 10.1007/s11695-019-04269-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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24
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Nedelcu M, Noel P, Manos T, Carandina S. Comment on: Outcomes of a novel bariatric stent in the management of sleeve gastrectomy leaks: a multicenter study. Surg Obes Relat Dis 2019; 15:e35-e36. [PMID: 31699652 DOI: 10.1016/j.soard.2019.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 08/17/2019] [Accepted: 08/19/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Marius Nedelcu
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obesite, Toulon, France; ELSAN, Clinique Bouchard, Marseille, France; Emirates Specialty Hospital, Dubai, United Arab Emirates
| | - Patrick Noel
- ELSAN, Clinique Bouchard, Marseille, France; Emirates Specialty Hospital, Dubai, United Arab Emirates
| | | | - Sergio Carandina
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obesite, Toulon, France
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25
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Low Incidence of Postoperative Leaks When Using Small-Diameter Calibrated Bougies During Laparoscopic Sleeve Gastrectomy: A Retrospective Cohort Study. World J Surg 2019; 44:849-854. [DOI: 10.1007/s00268-019-05233-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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26
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Noel P, Eddbali I, Nedelcu M, Lutfi R. The Interest of Enhanced Recovery After Surgery in a New Bariatric Center. J Laparoendosc Adv Surg Tech A 2019; 30:6-11. [PMID: 31573396 DOI: 10.1089/lap.2019.0456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: With the creation of a new bariatric center in Abu Dhabi, United Arab Emirates (UAE) and the organization of this bariatric department according to the international guidelines, a new activity of bariatric surgery started in January 2015. The surgeon had 20 years of experience in this field and he had performed over 5000 major laparoscopic bariatric procedures before starting this new bariatric program. The concept of enhanced recovery after bariatric surgery (ERABS) was applied from the beginning of the program. We decided to analyze the first 2 years of ERAS activity after having split them in two different periods: the 1st year of activity included restrictive procedures and the 2nd year associated malabsorptive surgeries. Materials and Methods: The results of the use of a fast-track program could be measured by different parameters like operative time, length of hospital stay, rate of complications, and rate of readmission and reoperation. Results: Between January and December 2015, 116 patients underwent a bariatric procedure. The mean age was 34.6 years (16-61) and average body mass index (BMI) was 41.7 kg/sqm (32-72.2). Sixty percent of patients were women and 37% of patients had at least one comorbidity (diabetes type 2, high blood pressure, hyperlipidemia, or sleep apnea). Ninety-four percent of the procedures were laparoscopic sleeve gastrectomy (LSG), 2.6% were laparoscopic Roux-en-Y gastric bypass, and 3.4% band removal. The mean operative time was 20 minutes for an LSG (14-45 minutes) and the average hospital stay was 1.2 days (standard deviation [SD]: 0.9-3.3). The rate of complications was 1.7% with 1 postoperative hematoma drained by CT scan on day 14 after the surgery and 1 relative stenosis endoscopically dilated on postoperative day 45. No reoperation was done. No leak was observed. At 1 year, the mean excess weight loss (EWL) was 64% (47-124) in 89 patients with a 76% rate of follow-up. For the 2nd year of activity in 2016, 142 patients went in the program. The mean age was 32.7 years (17-64) and average BMI was 42.3 kg/sqm (31-68). Seventy-two percent were women and 41% of the patients had one comorbidity or more. The majority of surgeries performed were LSG for 83.1% of the patients. RYGB was realized in 4.2% of cases, resleeve gastrectomy in 4.2%, and band removal in 1.4%. Some malabsorptive surgeries were performed as well, such as one anastomosis gastric bypass for 3 patients (4.2%), and single anastomosis duodeno-ilelal in 2 cases (2.8%). The average hospital stay was 1.5 days (SD: 0.9-3.5). No complication was observed. No reoperation was done. Two patients (1.4%) came back to the hospital on postoperative day 2 and 8 after a LSG for one or several episodes of vomiting without further complication. At 1 year, the mean EWL was 68% (49-154) in 98 patients with a 69% rate of follow-up. Conclusions: This new program of bariatric surgery in two steps using fast-track protocols, respecting international guidelines and with an experienced surgeon showed on its 1st year of implementation a 1.7% rate of readmission on 116 patients without reoperation or major complication and a hospital stay of 1.2 days. For the 2nd year of implementation with the inclusion of malabsorptive procedures only 2 patients (1.4%) were readmitted for a short episode of vomiting and the hospital stay was 1.5 days.
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Affiliation(s)
- Patrick Noel
- Bariatric and Metabolic Surgery Department, Mediclinic Parkview Hospital, Dubai, United Arab Emirates.,Bariatric and Metabolic Surgery Department, Centre de Chirurgie de l'Obésité de la clinique Saint Michel, Toulon, France
| | - Imane Eddbali
- Bariatric and Metabolic Surgery Department, Mediclinic Parkview Hospital, Dubai, United Arab Emirates
| | - Marius Nedelcu
- Bariatric and Metabolic Surgery Department, Centre de Chirurgie de l'Obésité de la clinique Saint Michel, Toulon, France
| | - Rami Lutfi
- Bariatric and Metabolic Surgery Department, Mercy Hospital and Medical Center, Chicago, Illinois
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Surgical management for chronic leak following sleeve gastrectomy: Review of literature. Surg Obes Relat Dis 2019; 15:1844-1849. [DOI: 10.1016/j.soard.2019.03.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/18/2019] [Accepted: 03/10/2019] [Indexed: 12/11/2022]
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El Chaar M, Stoltzfus J, Melitics M, Claros L, Zeido A. 30-Day Outcomes of Revisional Bariatric Stapling Procedures: First Report Based on MBSAQIP Data Registry. Obes Surg 2019; 28:2233-2240. [PMID: 29876840 DOI: 10.1007/s11695-018-3140-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The number of bariatric revisional cases has nearly doubled since 2011, and now comprises 13.6% of the total number of cases. The objective of this study is to evaluate the outcomes and safety of the two most common stapling revisional procedures, namely, sleeve and gastric bypass in comparison to primary stapling procedures using the MBSAQIP data registry. METHODS We reviewed all the sleeve and gastric bypass cases entered between January 1, 2015, and December 31, 2015, in the MBSAQIP data registry. We, then, identified sleeve and bypass patients who have had a previous bariatric procedure. Demographics and 30 day outcomes of all sleeve and gastric bypass patients were analyzed. We conducted within group comparisons comparing primary sleeve gastrectomy (PS) and primary gastric bypass (PB) patients to revisional sleeve (RS) and revisional gastric bypass (RB) patients, respectively. We, then, conducted group comparisons comparing RS to RB patients. RESULTS The total number of patients analyzed was 141,577 (98,292 or 69% sleeve patients and 43,285 or 31% gastric bypass patients). Among the sleeve patients, 92,666 (94%) had a PS and 5626 (6%) had RS. Among the bypass patients, 39,567 (91%) had a PB and 3718 patients (9%) had RB. 30-day readmission rate of RS was significantly higher as compared to PS (4.1 vs 0.4%, p < 0.05). The incidence of at least one complication requiring reoperation or reintervention within 30 days following RS was twice as high as compared to PS (1.9 and 2% for RS vs 0.9 and 1.1% for PS respectively, p < 0.05). Length of stay and 30 day mortality rates for PS and RS were the same. 30-day readmission rate of RB as compared to PB was 8.3 vs 6.3% (p < 0.05). Also, the incidence of at least one complication requiring reoperation or reintervention following RB was 3.9 and 4%, respectively vs 2.4 and 2.7% for PB (p < 0.05). In addition, readmission rates and unplanned admission rates to the ICU were significantly higher for RB compared to RS (8.3 and 2% for RB vs 4.1 and 0.9% for RS respectively, p < 0.05). The incidence of at least one reoperation or one intervention following RB were also significantly higher compared to RS (3.9 vs 1.9% and 4 vs 2% respectively, p < 0.05). CONCLUSION Revisional stapling procedures are safe but the rates of complications following RS and RB are twice as high compared to PS and PB. Also, RB are more likely to develop complications compared to RS.
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Affiliation(s)
- Maher El Chaar
- St Luke's University Hospital and Health Network, Allentown, PA, USA.
| | - Jill Stoltzfus
- St Luke's University Hospital and Health Network, Allentown, PA, USA
| | - Maureen Melitics
- St Luke's University Hospital and Health Network, Allentown, PA, USA
| | - Leonardo Claros
- St Luke's University Hospital and Health Network, Allentown, PA, USA
| | - Ahmad Zeido
- St Luke's University Hospital and Health Network, Allentown, PA, USA
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de Moura DTH, de Moura EGH, Neto MG, Jirapinyo P, Teixeira N, Orso I, Quadros LG, Amorim A, Medeiros F, Neto DR, de Siqueira Neto J, Albano A, de Sousa LH, Almeida D, Marchetti IA, Ivano F, de Lima JHF, Falcão M, Thompson CC. Outcomes of a novel bariatric stent in the management of sleeve gastrectomy leaks: a multicenter study. Surg Obes Relat Dis 2019; 15:1241-1251. [DOI: 10.1016/j.soard.2019.05.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 02/06/2023]
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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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Iannelli A, Treacy P, Sebastianelli L, Schiavo L, Martini F. Perioperative complications of sleeve gastrectomy: Review of the literature. J Minim Access Surg 2019; 15:1-7. [PMID: 29737316 PMCID: PMC6293679 DOI: 10.4103/jmas.jmas_271_17] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Sleeve gastrectomy (SG) has known a spectacular rise worldwide during the last decade. The absence of digestive anastomosis simplifies the surgical technique, reducing anastomosis-related complications such as fistula, stricture and marginal ulcer. Furthermore, the respect for digestive continuity preserves the functions of pylorus, that regulates gastric emptying, and duodenum, where calcium, B vitamins and iron are absorbed. Despite the multiple advantages, SG also has specific complications such as bleeding, stenosis, portal thrombosis and leak. The staple line leak at the oesophagogastric junction is the most feared complication and its prevention remains difficult, as the involved mechanisms have been only partially elucidated. Its management is long and requires a multidisciplinary technical platform including Intensive Care Unit, digestive endoscopy and interventional radiology as well as a specialised surgeon. The aim of this review is to explain in detail the perioperative complications of SG, their prevention and treatment, referring to the most recent available literature.
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Affiliation(s)
- Antonio Iannelli
- Digestive Surgery Unit, Archet 2 Hospital, University Hospital of Nice; Inserm, U1065, Team 8 "Hepatic Complications of Obesity"; University of Nice Sophia Antipolis, Nice, France
| | - Patrick Treacy
- Digestive Surgery Unit, Archet 2 Hospital, University Hospital of Nice, Nice, France
| | - Lionel Sebastianelli
- Digestive Surgery Unit, Archet 2 Hospital, University Hospital of Nice, Nice, France
| | - Luigi Schiavo
- Department of Cardio-Thoracic and Respiratory Science, University of Campania "Luigi Vanvitelli"; IX Division of General Surgery, Vascular Surgery and Applied Biotechnology, Naples University Polyclinic, Naples, Italy
| | - Francesco Martini
- Digestive and Bariatric Surgery Unit, Joseph Ducuing Hospital, Toulouse, France
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Abstract
Background and Objectives: Laparoscopic sleeve gastrectomy (LSG) has some unique complications, the most concerning of which is sleeve leak. Staple line reinforcement (SLR) has been suggested as a means of decreasing the risk of sleeve leak, but it increases the cost. However, there is little in the literature regarding the effect of standardized operative technique in reducing the complications and improving the outcomes in LSG. We sought to demonstrate that standardization of the operative procedure and perioperative care is the key to an excellent 30-day outcome and that SLR is not necessary to ensure a negligible staple line leak and bleeding rate. Methods: A prospectively maintained database was analyzed to identify 303 consecutive patients undergoing LSG between July 2010 and November 2017. Data on patient demographics, length of hospital stay, conversion to open surgery, perioperative complications, and mortality were analyzed. Standardized operative technique and postoperative protocol were followed in all cases. SLR was not used in any case. Results: Among 303 cases, there were 15 complications (5%), 5 (1.7%) of which were severe (Clavien-Dindo grade ≥3a). There were no conversions to open procedure, no staple line leaks, and no inpatient deaths in the cohort. No patient was readmitted with an early stricture. Conclusions: The use of a standardized operative and postoperative protocol led to an excellent early outcome in our LSG cases. Standardization may act to obviate the need for routine SLR techniques which are associated with a significant financial cost to both patient and hospital.
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Affiliation(s)
- William Lynn
- Department of Bariatric Surgery, Homerton University Hospital National Health Service Trust, London, United Kingdom
| | - Andrei Ilczyszyn
- Department of Bariatric Surgery, Homerton University Hospital National Health Service Trust, London, United Kingdom
| | - Rachel Aguilo
- Department of Bariatric Surgery, Homerton University Hospital National Health Service Trust, London, United Kingdom
| | - Sanjay Agrawal
- Department of Bariatric Surgery, Homerton University Hospital National Health Service Trust, London, United Kingdom
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Danan M, Nedelcu A, Noel P, Zulian V, Carandina S, Nedelcu M. Operative morbidity of laparoscopic sleeve gastrectomy in subjects older than age 65. Surg Obes Relat Dis 2018; 15:8-11. [PMID: 30928107 DOI: 10.1016/j.soard.2018.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/21/2018] [Accepted: 10/10/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Continuous developments in healthcare have led to an increase in average life expectancy. Obesity in aged persons is increasing and is more clearly associated with an increased risk of diabetes, cardiovascular disease, lipid abnormalities, mobility-limited problems, and other co-morbidities in this category of age. OBJECTIVES The aim of the present study was to report the outcomes of laparoscopic sleeve gastrectomy in patients >65 years of age. SETTING Private hospital, France. METHODS A retrospective review was performed from patients aged >65 years who had undergone laparoscopic sleeve gastrectomy (June 2011-December 2017). The data analyzed included age, co-morbidities, preoperative body mass index, length of hospital stay, and postoperative complications. RESULTS A total of 93 patients were included with a mean age of 68.8 years (range, 65-78); 73 were female (78.5 %), and the mean preoperative body mass index was 43.6 ± 5.4 kg/m2. Revisional surgery was well represented in 34.4% of cases. Thirty-two patients had a previous gastric band converted to laparoscopic sleeve gastrectomy, with 12 cases of 1-step revision (37.5%). Eleven patients (11.8%) had concomitant cholecystectomy. All procedures were performed laparoscopically with no peroperative complications. The median hospital stay was 3.1 days (1-6 d). Complications included 1 hematoma treated conservatively. The 30-day mortality rate was 0%. The mean excess weight loss at 1 year postoperatively was 67.1% (range, 34%-107%) with a follow-up rate of 78.1%. Resolution or improvement was observed in 65% of patients presenting with diabetes, in 72.5% of patients presenting with HTA, in 47.1% of patients presenting with dyslipidemia, and in 63.6% of patients presenting with sleep apnea. CONCLUSIONS Sleeve gastrectomy in elderly patients seems to be safe in terms of complications. Surgery is associated with a low-morbidity profile. Sleeve gastrectomy is our preferred procedure in this category of patients.
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Affiliation(s)
- Marc Danan
- ELSAN, Clinique St-Michel, Toulon, France
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34
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Noel P, Nedelcu M. Comment on: Current role of staple line reinforcement in 30-day outcomes of primary laparoscopic sleeve gastrectomy: An analysis of MBSAQIP data, 2015-2016 PUF. Surg Obes Relat Dis 2018; 14:1461-1462. [PMID: 30449507 DOI: 10.1016/j.soard.2018.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Patrick Noel
- ELSAN Clinique Saint Michel - Centre Chirurgical de l'Obésité, Toulon, France; ESH Dubai Healthcare City, Dubai, United Arab Emirates; Mediclinic Airport Road, Abu Dhabi, United Arab Emirates
| | - Marius Nedelcu
- ELSAN Clinique Saint Michel - Centre Chirurgical de l'Obésité, Toulon, France
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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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Effectiveness of Fibrin Sealant Application on the Development of Staple Line Complications After Sleeve Gastrectomy: A Prospective Randomized Trial. Ann Surg 2018; 268:762-768. [PMID: 30080735 DOI: 10.1097/sla.0000000000002892] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Evaluate the effectiveness of the use of fibrin sealant (FS) for preventing the development of staple line complications (SLCs) after sleeve gastrectomy (SG). BACKGROUND There is no consensus on the best means of preventing SLCs after SG. METHODS This was a prospective, intention-to-treat, randomized, 2 center study of a group of 586 patients undergoing primary SG (ClinicalTrials.gov identifier: NCT01613664) between March 2014 and June 2017. The 1:1 randomization was stratified by center, age, sex, gender, and body mass index, giving 293 patients in the FS group and 293 in the control group (without FS). The primary endpoint (composite criteria) was the incidence of SLCs in each of the 2 groups. The secondary criteria were the mortality rate, morbidity rate, reoperation rate, length of hospital stay, readmission rate, and risk factors for SLC. RESULTS There were no intergroup differences in demographic variables. In an intention-to-treat analysis, the incidence of SLCs was similar in the FS and control groups (1.3% vs 2%, respectively; P = 0.52). All secondary endpoints were similar: complication rate (5.4% vs 5.1%, respectively; P = 0.85), mortality rate (0.3% vs 0%, respectively; P = 0.99), GL rate (0.3% vs 1.3%, respectively; P = 0.18), postoperative hemorrhage/hematoma rate (1% vs 0.7%, respectively; P = 0.68), reoperation rate (1% vs 0.3%, respectively; P = 0.32). Length of stay was 1 day in both groups (P = 0.89), and the readmission rate was similar (5.1% vs 3.4%, respectively; P = 0.32). No risk factors for SLCs were found. CONCLUSION The incidence of postoperative SLCs did not appear to depend on the presence or absence of FS.
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Demeusy A, Sill A, Averbach A. Current role of staple line reinforcement in 30-day outcomes of primary laparoscopic sleeve gastrectomy: an analysis of MBSAQIP data, 2015-2016 PUF. Surg Obes Relat Dis 2018; 14:1454-1461. [PMID: 30098885 DOI: 10.1016/j.soard.2018.06.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/25/2018] [Accepted: 06/25/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has become a dominant bariatric procedure. In the past, significant leak rates prompted the search for staple line reinforcement (SLR) techniques. Previous analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database for all LSG suggested a detrimental influence of SLR on leak rates and overall morbidity. OBJECTIVE To investigate the relationship between various SLR techniques and bougie size with 30-day outcomes. SETTING Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program-accredited bariatric surgery hospitals. METHODS Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program 2015 to 2016 Participant Use File data, primary LSG cases were divided into study groups based on surgical techniques. All variables were reported in the Participant Use File except leak rate and overall morbidity, which had to be derived. Multiple bivariate analyses were used to analyze the 30-day outcomes. RESULTS A total of 198,339 primary LSG operations were included and grouped into No SLR (23.0%), SLR (54.2%), oversewn staple line (9.5%), and a combination of SLR + oversewn staple line (13.3%). There were no statistical differences between study groups in mortality, overall morbidity, or leak rate. Bleeding and reoperation rates were statistically higher in the No SLR group. Bougie size was not associated with change in leak rates. CONCLUSION Primary LSG is a safe procedure with low morbidity and mortality rates. SLR is associated with decreased rates of bleeding and reoperations but does not affect leak rates. The selection of SLR technique should be left to the surgeon's discretion with an understanding of the associated risks, benefits, and costs.
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Affiliation(s)
- Andrew Demeusy
- Department of Surgery, St. Agnes Hospital, Baltimore, Maryland.
| | - Anne Sill
- Department of Surgery, St. Agnes Hospital, Baltimore, Maryland
| | - Andrew Averbach
- Department of Surgery, St. Agnes Hospital, Baltimore, Maryland
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Chang SH, Freeman NLB, Lee JA, Stoll CRT, Calhoun AJ, Eagon JC, Colditz GA. Early major complications after bariatric surgery in the USA, 2003-2014: a systematic review and meta-analysis. Obes Rev 2018; 19:529-537. [PMID: 29266740 PMCID: PMC5880318 DOI: 10.1111/obr.12647] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/05/2017] [Accepted: 10/23/2017] [Indexed: 01/06/2023]
Abstract
The effectiveness of bariatric surgery has been well-studied. However, complications after bariatric surgery have been understudied. This review assesses <30-d major complications associated with bariatric procedures, including anastomotic leak, myocardial infarction and pulmonary embolism. This review included 71 studies conducted in the USA between 2003 and 2014 and 107,874 patients undergoing either gastric bypass, adjustable gastric banding or sleeve gastrectomy, with mean age of 44 years and pre-surgery body mass index of 46.5 kg m-2 . Less than 30-d anastomotic leak rate was 1.15%; myocardial infarction rate was 0.37%; pulmonary embolism rate was 1.17%. Among all patients, mortality rate following anastomotic leak, myocardial infarction and pulmonary embolism was 0.12%, 0.37% and 0.18%, respectively. Among surgical procedures, <30-d after surgery, sleeve gastrectomy (1.21% [95% confidence interval, 0.23-2.19%]) had higher anastomotic leak rate than gastric bypass (1.14% [95% confidence interval, 0.84-1.43%]); gastric bypass had higher rates of myocardial infarction and pulmonary embolism than adjustable gastric banding or sleeve gastrectomy. During the review, we found that the quality of complication reporting is lower than the reporting of other outcomes. In summary, <30-d rates of the three major complications after either one of the procedures range from 0% to 1.55%. Mortality following these complications ranges from 0% to 0.64%. Future studies reporting complications after bariatric surgery should improve their reporting quality.
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Affiliation(s)
- S-H Chang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - N L B Freeman
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.,Center for Advanced Methods Development, RTI International, NC, USA
| | - J A Lee
- Agricultural Statistics Laboratory, University of Arkansas, Fayetteville, AR, USA
| | - C R T Stoll
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - A J Calhoun
- Saint Louis University School of Medicine, St. Louis, MO, USA
| | - J C Eagon
- Minimally Invasive and Bariatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - G A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Staple Line Reinforcement in Laparoscopic SleeveGastrectomy: Experience in 1023 Consecutive Cases. Obes Surg 2017; 27:1474-1480. [PMID: 28054296 DOI: 10.1007/s11695-016-2530-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Laparoscopic sleeve gastrectomy (LSG) is one of the most frequently performed bariatric procedures performed worldwide. However, staple line-related complications have become a major challenge for bariatric surgeons. The aim of this study was to evaluate the morbidity in a cohort of patients who underwent LSG with imbricated oversewing of the staple line at a single high-volume center. MATERIALS AND METHODS We retrospectively reviewed prospectively collected data for all patients who underwent LSG to treat obesity at our institution from January 2010 to September 2016. All practitioners had undergone training with a single senior bariatric surgeon using oversewing as staple line reinforcement (SLR). RESULTS In total, 1023 LSGs were performed (female, 67.3%; mean age, 40.6 ± 10.8 years; median preoperative body mass index, 37 ± 4.5 kg/m2). The mean operative time was 67.6 ± 23.4 min (range, 30-150 min). The rate of conversion to open surgery was 0.3%. Early complications were noted in 18 patients (1.8%), including 5 cases of bleeding (0.5%). No leaks, stenosis, or mortality occurred. CONCLUSIONS LSG is a safe technique, but staple line-associated complications can be life-threatening. In this series, no leaks occurred from the very beginning of the surgeons' experience in LSG. Imbricated oversewing of the staple line, proper mentoring, and performance of surgery in appropriate settings are good approaches to decreasing complications.
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[Quality indicators for metabolic and bariatric surgery in Germany : Evidence-based development of an indicator panel for the quality of results, indications and structure]. Chirurg 2017; 89:4-16. [PMID: 29209749 DOI: 10.1007/s00104-017-0563-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
An expert committee was appointed by the German Society for General and Visceral Surgery to develop a panel of appropriate quality indicators to collate the quality of results, indications and structure in metabolic and bariatric surgery. This entailed assimilating the available evidence (systematic literature search), results from the national registry of the society (StuDoQ|MBE) and specific socioeconomic aspects (e. g. severely limited access to metabolic and bariatric surgery in Germany). These quality parameters were to be incorporated into the national guidelines and the rules of procedure for certification in the future. The committee concluded that mortality, MTL30 and severe complications needing intervention (Clavien-Dindo ≥ 3b) are suitable indicators to measure surgical outcome quality due to their relevance, scientific soundness and practicability. As a systematic follow-up is mandatory after bariatric surgery, a minimum follow-up quota is now required using reported quality of life data as an indicator of process quality. As intestinal bypass procedures have been shown to be superior in the treatment of type 2 diabetes, these procedures should be offered to eligible patients and also be performed. The proposed threshold values based on the results of the available literature and StuDoQ registry are to be considered as preliminary and need to be validated and adjusted if necessary in the future. The StuDoQ|MBE is considered a valuable tool to gather this information and also represents the appropriate infrastructure for the collation of relevant risk adjustors.
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Silecchia G, Iossa A. Complications of staple line and anastomoses following laparoscopic bariatric surgery. Ann Gastroenterol 2017; 31:56-64. [PMID: 29333067 PMCID: PMC5759613 DOI: 10.20524/aog.2017.0201] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/08/2017] [Indexed: 12/12/2022] Open
Abstract
With over 600 million people being obese, and given the scientific demonstration of the advantages of surgical treatment, bariatric surgery is on the rise. The promising long-term results in terms of weight loss, and particularly in relation to comorbidities and the control/cure rate, mean that the number of procedures performed in all countries remains high. However, the risk of potentially complex or fatal complications, though small, is present and is related to the procedures per se. This review is a guide for bariatric and/or general surgeons, offering a complete overview of the pathogenesis of anastomosis and staple line following the most common laparoscopic bariatric procedures: sleeve gastrectomy, gastric bypass, and mini-gastric bypass. The review is divided according to the procedure and the complications (leak, bleeding and stenosis), and evaluates all the factors that can potentially improve or worsen the complication rate, representing a “unicum” in the present literature on bariatric surgery.
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Affiliation(s)
- Gianfranco Silecchia
- Department of Medical-Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Centre of Excellence, University of Rome "La Sapienza", Rome, Italy
| | - Angelo Iossa
- Department of Medical-Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Centre of Excellence, University of Rome "La Sapienza", Rome, Italy
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Saglam K, Aktas A, Gundogan E, Ertugrul I, Tardu A, Karagul S, Kirmizi S, Sumer F, Ersan V, Kayaalp C. Management of Acute Sleeve Gastrectomy Leaks by Conversion to Roux-en-Y Gastric Bypass: a Small Case Series. Obes Surg 2017; 27:3061-3063. [DOI: 10.1007/s11695-017-2898-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Technical Details of Laparoscopic Sleeve Gastrectomy Leading to Lowered Leak Rate: Discussion of 1070 Consecutive Cases. Minim Invasive Surg 2017; 2017:4367059. [PMID: 28761766 PMCID: PMC5518516 DOI: 10.1155/2017/4367059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 04/24/2017] [Accepted: 05/29/2017] [Indexed: 01/06/2023] Open
Abstract
Introduction Laparoscopic sleeve gastrectomy is a widely utilized and effective surgical procedure for dramatic weight loss in obese patients. Leak at the sleeve staple line is the most serious complication of this procedure, occurring in 1–3% of cases. Techniques to minimize the risk of sleeve gastrectomy leaks have been published although no universally agreed upon set of techniques exists. This report describes a single-surgeon experience with an approach to sleeve leak prevention resulting in a progressive decrease in leak rate over 5 years. Methods 1070 consecutive sleeve gastrectomy cases between 2012 and 2016 were reviewed retrospectively. Patient characteristics, sleeve leaks, and percent body weight loss at 6 months were reported for each year. Conceptual and technical changes aimed towards leak reduction are presented. Results With the implementation of the described techniques of the sleeve gastrectomy, the rate of sleeve leaks fell from 4% in 2012 to 0% in 2015 and 2016 without a significant change in weight loss, as depicted by 6-month change in body weight and percent excess BMI lost. Conclusion In this single-surgeon experience, sleeve gastrectomy leak rate has fallen to 0% since the implementation of specific technical modifications in the procedure.
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Noel P, Nedelcu M. Ambulatory surgery for sleeve gastrectomy: terminology and concept. Surg Obes Relat Dis 2017; 13:1121-1122. [PMID: 28499886 DOI: 10.1016/j.soard.2017.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
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The role of bariatric endoscopy in the management of obesity. Surg Obes Relat Dis 2017. [PMID: 28648770 DOI: 10.1016/j.soard.2017.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Staple line leak with peritonitis after laparoscopic sleeve gastrectomy - a solution in one to six steps. Wideochir Inne Tech Maloinwazyjne 2017; 12:154-159. [PMID: 28694901 PMCID: PMC5502344 DOI: 10.5114/wiitm.2017.68297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 05/24/2017] [Indexed: 12/14/2022] Open
Abstract
Introduction Laparoscopic sleeve gastrectomy (LSG) is one of the most efficient bariatric interventions in morbidly obese patients. The most severe risk of this procedure seems to be the staple line leak, and the management of this complication can be very arduous. Aim To share our experience in managing the staple line leak after LSG and to help to find the best procedure that should be preferred. Material and methods In the 2010–2015 period we performed 223 LSG, with about 5 demonstrating severe complications – two patients with severe bleeding requiring revision surgery, and three patients with resection surface leak. Results We always primarily treated the staple line leak with a laparoscopic revision. Once the fistula did not spontaneously close after this treatment. A series of other methods were then indicated for this patient and only the sixth one resulted in the desirable therapeutic success. At first, our team opted for laparoscopic revision with drainage. The next procedure involved applying Ovesco and Boston clips. As a third method we performed abscess drainage through a nasobiliary tube inserted via gastroscopy. Due to failure we performed the second laparoscopic revision with staple line resuture, the next intervention was an open revision with fistula excision and suture, and finally we opted for the application of a self-expanding metallic stent, which proved to be definitely curative. Conclusions Without any guidelines it is very difficult to determine the right procedure addressing the staple line leak after LSG. It depends mainly on the clinician’s experience and is lengthy and often untraditional.
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Etiology of Leaks Following Sleeve Gastrectomy: Current Evidence. Surg Laparosc Endosc Percutan Tech 2017; 27:119-122. [DOI: 10.1097/sle.0000000000000400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Guetta O, Ovnat A, Czeiger D, Vakhrushev A, Tsaban G, Sebbag G. The Impact of Technical Surgical Aspects on Morbidity of 984 Patients after Sleeve Gastrectomy for Morbid Obesity. Obes Surg 2017; 27:2785-2791. [DOI: 10.1007/s11695-017-2721-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nedelcu M, Manos T, Gagner M, Eddbali I, Ahmed A, Noel P. Cost analysis of leak after sleeve gastrectomy. Surg Endosc 2017; 31:4446-4450. [PMID: 28378080 DOI: 10.1007/s00464-017-5495-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/28/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Leaks after laparoscopic sleeve gastrectomy (LSG) are serious complications of this procedure. The objective of the present study was to evaluate the costs of leaks after LSG. SETTING Private hospital, France. METHODS A retrospective analysis was conducted on a prospective cohort of 2012 cases of LSG between September 2005 and December 2014. Data were collected on all diagnostic and therapeutic measures necessary to manage leaks, ward, and intensive care unit (ICU) length of stay. Additional outpatient care was also analyzed. RESULTS Twenty cases (0.99%) of gastric leak were recorded. Fifteen patients had available data for cost analysis. Of these, 13 patients were women (86.7%) with a mean age of 41.4 years (range 22-61) and mean BMI of 43.2 kg/m2 (range 34.8-57.1). The leaks occurred after 7.4 days (±2.3) postoperatively. Only one gastric leak was recorded for the last 800 cases in which absorbable staple line reinforcement was used. Mean intra-hospital cost was 34398 € (range 7543-91,632 €). Prolonged hospitalization in ICU accounted for the majority of hospital costs (58.9%). Mean additional outpatient costs for leaks were 41,284 € (range 14,148-75,684€). CONCLUSIONS Leaks after LSG are an expensive complication. It is therefore important to take all necessary measures to reduce their incidence. Our data should be considered when analyzing the cost effectiveness of staple line reinforcement usage.
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Affiliation(s)
- Marius Nedelcu
- Centre Hospitalier Universitaire Montpellier, University Hospital of Montpellier, Montpellier, France. .,Digestive Surgery, University Hospital of Montpellier, 80, Avenue Augustin Fliche, 34295, Montpellier, France.
| | | | | | - Imane Eddbali
- The American Surgecenter, Abu Dhabi, United Arab Emirates
| | - Ahmed Ahmed
- St Mary's Hospital, Imperial College London, London, UK
| | - Patrick Noel
- The American Surgecenter, Abu Dhabi, United Arab Emirates
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Rebibo L, Cosse C, Robert B, Chivot C, Yzet T, Dhahri A, Regimbeau JM. Eliminating routine upper gastrointestinal contrast studies after sleeve gastrectomy decreases length of stay and hospitalization costs. Surg Obes Relat Dis 2017; 13:553-559. [DOI: 10.1016/j.soard.2016.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/14/2016] [Accepted: 10/16/2016] [Indexed: 02/06/2023]
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