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Belluzzi A, Sample JW, Marrero K, Tomey D, Puvvadi S, Sharma I, Ghanem OM. Rare Complications Following Laparoscopic Sleeve Gastrectomy. J Clin Med 2024; 13:4456. [PMID: 39124722 PMCID: PMC11313060 DOI: 10.3390/jcm13154456] [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: 07/08/2024] [Revised: 07/26/2024] [Accepted: 07/27/2024] [Indexed: 08/12/2024] Open
Abstract
Metabolic and bariatric surgery (MBS) is the most effective and durable therapeutic intervention for patients with obesity. In recent years, laparoscopic sleeve gastrectomy (SG) has become the most commonly performed primary MBS procedure owing to its technical feasibility and excellent short-term outcomes. Despite these favorable results and perceived advantages, SG is associated with several unique complications. Complications such as a postoperative leak or bleeding have been more commonly observed and reported than others, and their management approaches are well described. However, other complications following SG are far less familiar to surgeons, which may delay recognition and result in poor patient outcomes. Of these complications, we describe splenic injuries; esophageal perforation; staple line malformations; stapling of intraluminal devices; phytobezoar formation; gastro-colic, gastro-pleural and gastro-bronchial fistula; pancreatic leak; and portomesenteric venous thrombosis. It is paramount for surgeons to be aware of these underreported issues and have the resources to learn how to recognize and manage them when they arise. This review aims to describe rare (i.e., reported incidence <1%) and underdescribed complications after SG, focusing on causes, clinical presentation, prevention strategies, and management.
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Affiliation(s)
- Amanda Belluzzi
- Department of Surgery, Mayo Clinic, Rochester, MN 55095, USA; (A.B.); (J.W.S.)
- Department of Surgery, Rovigo Hospital, 45100 Rovigo, Italy
| | - Jack W. Sample
- Department of Surgery, Mayo Clinic, Rochester, MN 55095, USA; (A.B.); (J.W.S.)
| | - Katie Marrero
- Carle Foundation Hospital General Surgery Residency, Champaign, IL 61801, USA
| | - Daniel Tomey
- Department of General Surgery, Houston Methodist Hospital, Houston, TX 77030, USA;
| | - Suraj Puvvadi
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA
| | - Ishna Sharma
- St. Peter’s Health Partners Bariatric and Metabolic Care, Albany, NY 12208, USA;
| | - Omar M. Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN 55095, USA; (A.B.); (J.W.S.)
- Division of Metabolic and Abdominal Wall Reconstructive Surgery, Mayo Clinic, Rochester, MN 55095, USA
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Movahhed GK, Dalili A, Zandbaf T, Rezapanah A, Jangjoo A, Seyfari B. A rare presentation of gastro-pleural fistula after Roux-en-Y gastric bypass, simultaneous fistula of gastric pouch, and remnant to the pleural space. Clin Case Rep 2023; 11:e8317. [PMID: 38107082 PMCID: PMC10724080 DOI: 10.1002/ccr3.8317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 12/19/2023] Open
Abstract
Key Clinical Message Although gastro-pleural fistulas after bariatric surgeries are rare, they are life-threatening complications that should be suspected in patients who present with gastrointestinal or respiratory symptoms after bariatric surgery. Abstract Previous studies showed an incidence rate of 0.2%-0.37% for gastro-pleural fistulas after bariatric surgery. We report a 56-year-old female with a rare presentation of gastro-pleural fistula after Roux-en-Y gastric bypass, simultaneous fistula of the gastric pouch, and remnant to the pleural space.
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Affiliation(s)
| | - Amin Dalili
- Surgical Oncology Research CenterMashhad University of Medical SciencesMashhadIran
| | - Tooraj Zandbaf
- Department of General Surgery, Faculty of Medicine, Mashhad Medical SciencesIslamic Azad UniversityMashhadIran
| | - Alireza Rezapanah
- Surgical Oncology Research CenterMashhad University of Medical SciencesMashhadIran
| | - Ali Jangjoo
- Surgical Oncology Research CenterMashhad University of Medical SciencesMashhadIran
| | - Benyamin Seyfari
- Surgical Oncology Research CenterMashhad University of Medical SciencesMashhadIran
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3
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Belle S, Kouladouros K, Kähler G. [Management of Endoscopic Complications after Bariatric Surgery: Focus on Current Endoscopic Therapy]. Zentralbl Chir 2022; 147:539-546. [PMID: 36479650 DOI: 10.1055/a-1962-6910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In bariatric surgery, complications are rare. Most of the complications can be managed by endoscopy. Rare complications impose a challenge in everyday clinical work. To optimally treat the complications and to minimise the harm to the patient it is important to implement complication management. This review gives an overview of relevant bariatric complications and endoscopic therapy strategies, focusing on published literature of the last five years. This manuscript could be a starting point for complication management in the clinic.
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Affiliation(s)
- Sebastian Belle
- Zentrale Interdisziplinäre Endoskopie (ZIE), Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Konstantinos Kouladouros
- Chirurgie, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Georg Kähler
- Chirurgie, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
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Mongardini FM, Cacciatore C, Catauro A, Maglione F, Picardi F, Lauro A, Gambardella C, Allaria A, Docimo L. Stemming the Leak: A Novel Treatment for Gastro-Bronchial Fistula. Dig Dis Sci 2022; 67:5425-5432. [PMID: 36251132 DOI: 10.1007/s10620-022-07711-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 01/05/2023]
Abstract
Laparoscopic sleeve gastrectomy (LSG) is a commonly used procedure in bariatric patients that often has excellent results. Despite its advantages, LSG is burdened by specific intraoperative and postoperative early and late complications. One of the life-threatening complications is gastric fistula, usually treated with a multidisciplinary surgical-endoscopic approach. In case of failure of the latter, alternative nonoperative techniques such as the use of autologous stem cells truly represents an innovative possibility, with only few cases described in literature. Here, we report the case of a 25-year-old man with post-LSG broncho-gastric fistula treated with application of autologous stem cells after the failure of the conventional surgical/endoscopic approach.
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Affiliation(s)
- F M Mongardini
- General, Mini-invasive, Oncological and Obesity Surgery Unit, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - C Cacciatore
- General, Mini-invasive, Oncological and Obesity Surgery Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - A Catauro
- General, Mini-invasive, Oncological and Obesity Surgery Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - F Maglione
- General, Mini-invasive, Oncological and Obesity Surgery Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - F Picardi
- General, Mini-invasive, Oncological and Obesity Surgery Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - A Lauro
- General, Mini-invasive, Oncological and Obesity Surgery Unit, University of Campania "Luigi Vanvitelli", Naples, Italy.,Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - C Gambardella
- General, Mini-invasive, Oncological and Obesity Surgery Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - A Allaria
- General, Mini-invasive, Oncological and Obesity Surgery Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - L Docimo
- General, Mini-invasive, Oncological and Obesity Surgery Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
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Role of Endoscopic Internal Drainage in Treating Gastro-Bronchial and Gastro-Colic Fistula After Sleeve Gastrectomy. Obes Surg 2021; 32:342-348. [PMID: 34780026 DOI: 10.1007/s11695-021-05794-z] [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: 08/30/2021] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Gastro-bronchial and gastro-colic fistulas (GB-GC) represent a rare, but serious complication after laparoscopic sleeve gastrectomy (LSG). The aim of this study is to evaluate the efficacy of endoscopic first-line approach with endoscopic internal drainage (EID) by inserting double pigtail stents (DPS) METHODS: We retrospectively analyzed data from 40 consecutive patients referred at two tertiary centers for gastro-bronchial (N=30) and gastrocolic (N=10) fistulas following LSG. Nineteen patients previously experienced emergency surgical drainage. The mean interval between the index surgery and endoscopic fistula treatment was 265.6±521 days. RESULTS Healing of the fistulous tract was achieved in 19 patients (47.5%), with complete resolution at an average follow-up of 16 months. Mean time of treatment duration was 157.8±141 days with 5.0±2.9 endoscopic sessions. No major adverse events were registered. CONCLUSIONS Despite complete fistula healing was achieved in less than 50% of our population, EID for GB/GC fistula after LSG still represents the most conservative approach with low complications rate. Previous surgical drainage seems to be a positive prognostic factor for endoscopic healing. While the longer the interval between the index surgery and endoscopic treatment, the lower was the rate of treatment success.
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Vitiello A, Berardi G, Velotti N, Schiavone V, Musella M. Learning curve and global benchmark values of laparoscopic sleeve gastrectomy: results of first 100 cases of a newly trained surgeon in an Italian center of excellence. Updates Surg 2021; 73:1891-1898. [PMID: 34189700 PMCID: PMC8500908 DOI: 10.1007/s13304-021-01121-4] [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: 02/18/2021] [Accepted: 06/20/2021] [Indexed: 12/12/2022]
Abstract
To evaluate whether the learning curve for sleeve gastrectomy could be completed after 50 cases. First 100 patients undergoing LSG under a newly trained laparoscopic surgeon were included in this study and divided into two groups of 50 consecutive patients each. Perioperative outcomes were compared to recently introduced global benchmarks. Short-term weight loss was calculated as Total Weight Loss Percent (%TWL) and complications were classified in accordance with the Clavien–Dindo classification. CUSUM analysis was performed for operative time and hospital stay. Mean preoperative age and BMI were 41.8 ± 10.3 years and 42.9 ± 5.4 kg/m2, respectively. Demographics and rate of patients with previous surgery were comparable preoperatively in the two groups. Mean operative time was 92.1 ± 19.3 min and hospital stay was 3.4 ± 0.6 days as per our standard protocol of discharge. Uneventful postoperative course was recorded in 93% of patients and only one case of staple line leak was registered in the first 50 cases (group 1). No statistical difference in BMI and %TWL was found between the two groups at any time of follow-up. Comparison between two groups showed a significant reduction in hospital stay and operative time after the first 50 LSGs (p < 0.05). LSG can be performed by newly trained surgeons proctored by senior tutors. At least 50 cases are needed to meet global benchmark cut-offs and few more cases may be required to reach the plateau of the learning curve.
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Affiliation(s)
- Antonio Vitiello
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy.
| | - Giovanna Berardi
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Nunzio Velotti
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Vincenzo Schiavone
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Mario Musella
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy
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Roux-en-Y Gastrojejunostomy as an Efficient Treatment for Gastrobronchial Fistula Following Sleeve Gastrectomy Leak. Obes Surg 2021; 31:3857-3859. [PMID: 33834372 PMCID: PMC8031337 DOI: 10.1007/s11695-021-05406-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 11/26/2022]
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Gastrobronchial Fistula: A Rare Complication of Postlaparascopic Sleeve Gastrectomy-A Case Report and Literature Review. Case Rep Radiol 2021; 2021:6641319. [PMID: 33815858 PMCID: PMC7990559 DOI: 10.1155/2021/6641319] [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: 10/17/2020] [Revised: 02/20/2021] [Accepted: 02/27/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Obesity is one of the leading causes of morbidity and mortality in countries all over the world, and its prevalence has been increasing dramatically in recent years. Bariatric surgery is considered the gold standard of care for patients who failed conservative management. Laparoscopic sleeve gastrectomy (LSG) is of increasing popularity. One of its vicious consequences is the development of acquired fistula between the stomach and the tracheobronchial tract due to intractable gastric leak. Case Report. We are presenting a case of a 25-year-old man who underwent laparoscopic sleeve gastrectomy for morbid obesity, which was complicated with the development of gastrobronchial fistula, despite an unremarkable postoperative course. Conclusion Acquired gastrobronchial fistula due to bariatric surgery is not reported widely in radiologic literature; hence, there is lack of consensus of the diagnostic modality of choice. However, there is a myriad of tests available for diagnosing gastrobronchial fistula, with contrast study of the upper gastrointestinal tract which is the widely accepted diagnostic test.
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Sakran N, Zakeri R, Madhok B, Graham Y, Parmar C, Mahawar K, Pouwels S. Gastric Fistula in the Chest After Sleeve Gastrectomy: a Systematic Review of Diagnostic and Treatment Options. Obes Surg 2020; 31:357-369. [PMID: 33123868 DOI: 10.1007/s11695-020-05078-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 12/31/2022]
Abstract
This study aimed to establish the optimal diagnostic and treatment algorithm for the management of gastric fistula in the chest (GFIC) after sleeve gastrectomy (SG) through a systematic review of published cases. A multi-database search was performed, which produced 1182 results, of which 26 studies were included in this systematic review. The initial presentation included subphrenic collections, leaks, or (recurrent) pneumonia with associated symptoms such as persistent cough, fever, and/or dyspnea. Computed tomography (CT) scan in combination with either upper gastrointestinal (UGI) series or an esophagogastroduodenoscopy (EGD) was used to adequately diagnose the fistulas. Initial treatment was either with clips and/or clips and stents that were placed endoscopically. When unsuccessful in the majority of the cases, the surgical treatment consisted of total gastrectomy and Roux-en-Y esophagojejunostomy in a laparoscopic or open fashion.
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Affiliation(s)
- Nasser Sakran
- Department of Surgery, Emek Medical Center, 21 Izhak Rabin Blvd, 1834111, Afula, Israel. .,The Technion - Israel Institute of Technology, Haifa, Israel.
| | - Roxanna Zakeri
- Department of Surgery, University College London Hospital NHS Foundation Trust, London, UK
| | - Brijesh Madhok
- University Hospital of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Yitka Graham
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK.,Facultad de Psucologia, Universidad Anahuac Mexico, Mexico City, Mexico.,Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK
| | | | - Kamal Mahawar
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK.,Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
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