1
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Xi C, Yuan C, Liu J, Wang J, Ling Y. Factors influencing quality of life in early-stage upper gastrointestinal cancer patients in Nanchong city: a qualitative study. Am J Transl Res 2024; 16:3427-3436. [PMID: 39114679 PMCID: PMC11301490 DOI: 10.62347/ezon6207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 06/06/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVES To identify the determinants of quality of life (QoL) among early-stage upper gastrointestinal cancer (UGIC) patients in Nanchong City to inform the development of targeted treatment plans. METHODS In this retrospective study, 642 patients diagnosed with UGIC were included. A phenomenological approach was employed, involving in-depth face-to-face interviews to explore patients' real-life experiences with QoL, with an emphasis on spiritual and psychological aspects. Data analysis followed Colaizzi's seven-step method. Statistical analyses included one-way Analysis of Variance (ANOVA), t-tests, binary logistic regression, and Pearson correlation tests. RESULTS QoL was significantly reduced in patients with early-stage GI cancer (P<0.001), with prevalent symptoms of anxiety and depression necessitating focused psychological interventions and enhanced medical care. Influential factors on QoL included income, health insurance coverage, illness duration, and levels of anxiety and depression (P<0.001). A strong negative correlation was observed between QoL scores and both the Hamilton Anxiety Scale (r=-0.7808, P<0.001) and the Hamilton Depression Rating Scale (r=-0.7493, P<0.001). CONCLUSION This study underscores the substantial impact of anxiety and depression on the QoL of patients with early-stage UGIC. The findings provide a theoretical basis for implementing comprehensive long-term care strategies.
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Affiliation(s)
- Chunhui Xi
- Digestive System Department, Affiliated Hospital of North Sichuan Medical College Nanchong 637000, Sichuan, China
| | - Cong Yuan
- Digestive System Department, Affiliated Hospital of North Sichuan Medical College Nanchong 637000, Sichuan, China
| | - Juan Liu
- Digestive System Department, Affiliated Hospital of North Sichuan Medical College Nanchong 637000, Sichuan, China
| | - Jun Wang
- Digestive System Department, Affiliated Hospital of North Sichuan Medical College Nanchong 637000, Sichuan, China
| | - Ying Ling
- Digestive System Department, Affiliated Hospital of North Sichuan Medical College Nanchong 637000, Sichuan, China
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2
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Gensthaler L, Stauffer M, Jedamzik J, Bichler C, Nixdorf L, Richwien P, Eichelter J, Langer FB, Prager G, Felsenreich DM. Endoluminal Vacuum Therapy as Effective Treatment for Patients with Postoperative Leakage After Metabolic Bariatric Surgery-A Single-Center Experience. Obes Surg 2024:10.1007/s11695-024-07367-2. [PMID: 39046624 DOI: 10.1007/s11695-024-07367-2] [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: 03/04/2024] [Revised: 06/09/2024] [Accepted: 06/14/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Metabolic bariatric surgery (MBS) is standardized and safe. Nevertheless, complications such as anastomotic leakage (AL) or staple-line leakage (SLL) can occur. In upper GI or colorectal surgery, endoluminal vacuum therapy (EVT) offers a therapeutic alternative to revisional surgery. Data on EVT in patients with leakage after MBS remain scarce. The aim of this study is to evaluate the efficacy of EVT and its potential as endoscopic alternative to revisional surgery. MATERIAL AND METHODS All patients treated for AL or SLL with EVT after MBS between 01/2016 and 08/2023 at the Department for General Surgery, Medical University Vienna, were included in this retrospective, single-center study. Therapeutic value of EVT as management option for acute postoperative leakage after MBS in daily practice was evaluated. Statistical analyses were performed descriptively. RESULTS Twenty-one patients were treated with EVT within the observational period of 7 years. In 11 cases (52.4%), the index surgery was a primary bariatric intervention; in 10 cases (47.6%), a secondary surgery after initial MBS was performed. Favored approach was a combination of revisional surgery and EVT (n = 18; 85.7%), intermediate self-expanding metal stent (SEMS) in 16 (76.2%) cases. EVT was changed six times (0-33) every 3-4 days. Mean EVT time was 25.1 days (3-97). No severe associated complications were detected and EVT showed an efficacy of 95.2%. CONCLUSION This small case series supports the trend to establish EVT in daily clinical practice when revisional surgery after MBS is needed, thus preventing further reoperation and reducing associated morbidity and mortality in critically ill patients.
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Affiliation(s)
- L Gensthaler
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - M Stauffer
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - J Jedamzik
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - C Bichler
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - L Nixdorf
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - P Richwien
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - J Eichelter
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - F B Langer
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - G Prager
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - D M Felsenreich
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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3
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Firkins SA, Simons-Linares R. Management of leakage and fistulas after bariatric surgery. Best Pract Res Clin Gastroenterol 2024; 70:101926. [PMID: 39053976 DOI: 10.1016/j.bpg.2024.101926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 06/04/2024] [Indexed: 07/27/2024]
Affiliation(s)
- Stephen A Firkins
- Bariatric and Metabolic Endoscopy, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Roberto Simons-Linares
- Bariatric and Metabolic Endoscopy, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
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4
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Triantafyllou E, Scholer V, Calabrese D, Ribeiro-Parenti L, Msika S, Rebibo L. Is Routine Post-operative Biological Laboratory Assessment Necessary After Sleeve Gastrectomy? Obes Surg 2024; 34:707-715. [PMID: 38273145 DOI: 10.1007/s11695-024-07065-z] [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: 05/17/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Incidence of post-operative complications after sleeve gastrectomy (SG) is low. However, the early identification of these complications remains crucial. Here, we report the impact of routine laboratory monitoring for the early diagnosis of complications after SG. MATERIAL AND METHODS From January 2018 to December 2019, all consecutive patients who underwent primary SG (n = 457) were included. This was a comparative study of patients undergoing primary SG. Patients were divided into two groups: one group with routine laboratory monitoring performed at postoperative day (POD) 1 and 3 (LAB group) and another group without routine laboratory monitoring (control group). The study's primary endpoint was the overall impact of routine laboratory monitoring. The secondary endpoints were evaluation of patients with complications. RESULTS The population in the two groups were similar in term of demographic and intra-operative data. There was a statistical difference between the two groups in term of length of stay (5.7 days in the LAB group and 3.5 days in the control group (p < 0.001)). There were 19 complications (6.0%) in the LAB group and 5 complications in the control group (3.5%) (p = 0.25). A cut-off C-reactive protein level of 46.3 mg/l was found to be significant (p = 0.006). In the LAB group, 9 patients (2.9%) required readmission vs. three patients (2.0%) in the control group (p = 0.62). CONCLUSION The interest of routine laboratory monitoring after SG seems limited. Routine laboratory monitoring alone is not associated with earlier diagnosis of complications. This routine monitoring is associated with an increase of stay in hospital.
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Affiliation(s)
- Evangelia Triantafyllou
- Service de Chirurgie Digestive, Oesogastrique Et Bariatrique, Hôpital Bichat Claude Bernard, APHP, 75018, Paris, France
| | - Vincent Scholer
- Service de Chirurgie Digestive, Oesogastrique Et Bariatrique, Hôpital Bichat Claude Bernard, APHP, 75018, Paris, France
- Service de Chirurgie, GHI Le Raincy-Montfermeil, 93370, Montfermeil, France
| | - Daniela Calabrese
- Service de Chirurgie Digestive, Oesogastrique Et Bariatrique, Hôpital Bichat Claude Bernard, APHP, 75018, Paris, France
- Université de Paris, Inserm UMR 1149, 75018, Paris, France
| | - Lara Ribeiro-Parenti
- Service de Chirurgie Digestive, Oesogastrique Et Bariatrique, Hôpital Bichat Claude Bernard, APHP, 75018, Paris, France
- Université de Paris, Inserm UMR 1149, 75018, Paris, France
| | - Simon Msika
- Service de Chirurgie Digestive, Oesogastrique Et Bariatrique, Hôpital Bichat Claude Bernard, APHP, 75018, Paris, France
- Université de Paris, Inserm UMR 1149, 75018, Paris, France
| | - Lionel Rebibo
- Université de Paris, Inserm UMR 1149, 75018, Paris, France.
- Service de Chirurgie Digestive Et Oncologique, Hôpital Européen Georges Pompidou, APHP, 75015, Paris, France.
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5
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Mohamedahmed AYY, Hamid M, Zaman S, Abdalla HE, Wuheb AA, Khan A, Parmar J. Does Omentopexy Make a Difference in Laparoscopic Sleeve Gastrectomy for Obesity Treatment? A Systematic Review and Meta-Analysis. Obes Surg 2024; 34:218-235. [PMID: 38038906 DOI: 10.1007/s11695-023-06956-x] [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: 06/14/2023] [Revised: 11/04/2023] [Accepted: 11/13/2023] [Indexed: 12/02/2023]
Abstract
This systematic review and meta-analysis aimed to evaluate the comparative outcomes of laparoscopic sleeve gastrectomy with omentopexy (LSGO) versus conventional laparoscopic sleeve gastrectomy (LSG) for obesity treatment. A systematic online search was conducted using the available online databases, and Revman software was used for data analysis. Twenty-two eligible comparative studies were included (n = 9,321). LSGO showed a significantly lower rate of gastric leak (P = 0.0001), staple line bleeding (P = 0.00001), and gastric torsion (P = 0.002) in comparison to the LSG group. Operative time was significantly shorter in the LSG group (P = 0.00001); however, the length of hospital stay was in favour of the LSGO (P = 0.00001). Compared to LSG without omentopexy, LSG with omentopexy provides a significantly lower rate of postoperative complications and shorter LOS at the expense of operative time.
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Affiliation(s)
- Ali Yasen Y Mohamedahmed
- Department of General and Upper GI Surgery, The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, West Midlands, UK.
| | - Mohammed Hamid
- Department of General Surgery, The Dudley Group NHS Trust, Dudley, West Midlands, UK
| | - Shafquat Zaman
- Department of General Surgery, Sandwell and West, Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK
- Institute of Cancer and Genomic Science, College of Medical and Dental Science, University of Birmingham, Edgbaston, Birmingham, UK
| | - Hashim E Abdalla
- Department of General and Upper GI Surgery, The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, West Midlands, UK
| | - Ali Ahmed Wuheb
- Department of General and Upper GI Surgery, The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, West Midlands, UK
| | - Amir Khan
- Department of General Surgery, Walsall Manor Hospital, Walsall, West Midlands, UK
| | - Jitesh Parmar
- Department of General and Upper GI Surgery, The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, West Midlands, UK
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6
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Nandipati KC, Bremer KC. Bariatric Surgery Emergencies in Acute Care Surgery. Surg Clin North Am 2023; 103:1113-1131. [PMID: 37838459 DOI: 10.1016/j.suc.2023.05.013] [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] [Indexed: 10/16/2023]
Abstract
Patients who have undergone bariatric surgery present unique challenges in the acute care surgery setting. This review includes the presentation, workup, and management of most common bariatric surgery emergencies encountered by acute care surgery.
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Affiliation(s)
- Kalyana C Nandipati
- Division of Clinical Research, Department of Surgery, Creighton University School of Medicine, Minimally Invasive Surgery, Creighton University Education Building, 7710 Mercy Road, Suite 501, Omaha, NE 68124-2368, USA.
| | - Kristin C Bremer
- Department of Surgery, Creighton University School of Medicine, Creighton University Education Building, 7710 Mercy Road, Suite 501, Omaha, NE 68124-2368, USA
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7
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Oshiro T, Wakamatsu K, Nabekura T, Moriyama Y, Kitahara N, Kadoya K, Sato A, Kitahara T, Urita T, Sato Y, Nagashima M, Tsuchiya M, Okazumi S. Treatments for Staple Line Leakage after Laparoscopic Sleeve Gastrectomy. J Clin Med 2023; 12:jcm12103495. [PMID: 37240601 DOI: 10.3390/jcm12103495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/29/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
The number of laparoscopic sleeve gastrectomies (LSGs) performed in patients with obesity who are eligible for bariatric and metabolic surgery is currently much lower in Japan than in other countries. Considering the large number of potential patients with obesity and type 2 diabetes and the unique Japanese national health insurance system that guarantees fair healthcare delivery, there is room to increase the number of LSGs in Japan in the near future. However, strict health insurance regulations may limit access to mandatory devices needed to treat postoperative complications, such as staple line leakage, which can cause severe morbidity and even mortality. Therefore, understanding the pathogenesis and treatment options for this complication is crucial. This article examined the current situation in Japan and its impact on staple line leakage management, including the role of endoscopic treatment in reducing reoperation. The authors suggest increasing education and collaboration between healthcare professionals to optimize management and improve patient outcomes.
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Affiliation(s)
- Takashi Oshiro
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Kotaro Wakamatsu
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Taiki Nabekura
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Yuki Moriyama
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Natsumi Kitahara
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Kengo Kadoya
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Ayami Sato
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Tomoaki Kitahara
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Tasuku Urita
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Yu Sato
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Makoto Nagashima
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Masaru Tsuchiya
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Shinichi Okazumi
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
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8
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Chang SW, Pan HM, Liao GS, Hsu KF. An uncommon complication after laparoscopic revisional single anastomosis sleeve jejunal bypass (SASJ) with management of Roux-en-Y fistulojejunostomy: A case report. Asian J Surg 2023; 46:1397-1399. [PMID: 36123209 DOI: 10.1016/j.asjsur.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/02/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Shu-Wei Chang
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-Mei Pan
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Guo-Shiou Liao
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kuo-Feng Hsu
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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9
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Kolyadko PV, Kolyadko VP, Degovtsov EN, Samoilov VS, Stepanenko AV. [Non-surgical treatment of staple-line suture leakage after redo sleeve gastrectomy]. Khirurgiia (Mosk) 2023:83-89. [PMID: 36800874 DOI: 10.17116/hirurgia202303183] [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: 02/22/2023]
Abstract
Redo bariatric procedures are common. However, redo sleeve gastrectomy is not a frequent case of repeated bariatric surgery and can be performed rather as a necessary measure in difficult intraoperative conditions. We report a patient who underwent laparoscopic adjustable gastric band placement, its blockage and surgical removal, sleeve gastrectomy and redo sleeve gastrectomy. After that, staple-line suture failure developed that required endoscopic clipping.
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Affiliation(s)
- P V Kolyadko
- Nizhnevartovsk District Clinical Hospital, Nizhnevartovsk, Russia
| | - V P Kolyadko
- Nizhnevartovsk District Clinical Hospital, Nizhnevartovsk, Russia
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10
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Alharbi SR. Plain X-ray findings of post sleeve gastrectomy gastric leak. J Clin Imaging Sci 2022; 12:28. [PMID: 35673589 PMCID: PMC9168391 DOI: 10.25259/jcis_6_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/16/2022] [Indexed: 11/14/2022] Open
Abstract
Gastric leak following sleeve gastrectomy (SG) is a rare but significant cause of morbidity and mortality. A high clinical index of suspicion is the most sensitive approach to detect gastric leaks. Computed tomography (CT) is the gold standard diagnostic technique, although it might not be performed due to unavailability, and the inability to image superobese patients due to limited CT gantry space. Early detection and management are critical for attaining a better prognosis. The following pictorial review discusses the various plain X-ray radiographic findings that indicate a gastric leak. These findings may be overlooked, however, they remain valuable in patients with clinically suspected gastric leaks. This pictorial review illustrates the spectrum of findings related to post-SG gastric leak encountered in plain X-ray radiography.
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Affiliation(s)
- Sultan R Alharbi
- Department of Radiology and Medical Imaging, College of Medicine, King Saud University, Riyadh, Saudi Arabia,
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11
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Pavone G, Tartaglia N, Pacilli M, Maddalena F, Petruzzelli F, Ambrosi A. Leak after sleeve gastrectomy with positive intraoperative indocyanine green test: Avoidable scenario? Int J Surg Case Rep 2022; 95:107168. [PMID: 35567877 PMCID: PMC9111972 DOI: 10.1016/j.ijscr.2022.107168] [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: 04/21/2022] [Revised: 05/02/2022] [Accepted: 05/02/2022] [Indexed: 11/23/2022] Open
Abstract
Background The staple line gastric leak (GL) is estimated to be the most serious complication of the sleeve gastrectomy. The use of indocyanine green (ICG) has been introduced in minimally invasive surgery to show the vascularization of the stomach in real time and its application to the gastroesophageal junction (GE) during Laparoscopic Sleeve Gastrectomy (LSG) seems very promising. Case presentation We present the case of a 40-year-old female underwent laparoscopic sleeve gastrectomy. Intraoperative indocyanine green test showed a small dark area in the proximal third of the staple line reinforced with fibrin glue. Two weeks later the patient presented to the emergency room (ED) with abdominal pain, fever, vomiting, intolerance to oral intake and the evidence of a leak on the abdomen Computer Tomography (CT). The UIN for ClinicalTrial.gov Protocol Registration and Results System is: NCT05337644 for the Organization UFoggia. Conclusions This case report shows that intraoperative ICG test can be helpful in determining which patients are at greater risk of the leak and, more importantly, the cause of the leak but further tests are needed to determine if the ICG predicts leak due to ischemia. Fistulas after sleeve gastrectomy are complex and have multifactorial origins. Indocyanine Green (ICG) is a liquid that can be injected into the human bloodstream without adverse effects. This is a case report of a 40-year-old female with a positive intraoperative indocyanine green test as a prediction of the leak after sleeve gastrectomy.
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Affiliation(s)
- Giovanna Pavone
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122 Foggia, Italy.
| | - Nicola Tartaglia
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122 Foggia, Italy.
| | - Mario Pacilli
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122 Foggia, Italy.
| | - Francesca Maddalena
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122 Foggia, Italy
| | - Fabio Petruzzelli
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122 Foggia, Italy
| | - Antonio Ambrosi
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122 Foggia, Italy.
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12
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Lainas P, Triantafyllou E, Chagué P, Dammaro C, Maitre S, Rocher L, Dagher I. Routine Early Computed Tomography Scanner After Laparoscopic Sleeve Gastrectomy in High-Risk Severely Obese Patients Is Effective for Bleeding or Hematoma Diagnosis but not for Staple-Line Leak Detection: a Prospective Study. Obes Surg 2022; 32:1624-1630. [PMID: 35292901 DOI: 10.1007/s11695-022-05997-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 12/20/2022]
Abstract
PURPOSE Laparoscopic sleeve gastrectomy (LSG) is the most frequently performed bariatric procedure worldwide. Postoperative staple-line leak and intraabdominal hemorrhage can increase associated morbidity and mortality. The value of routine early computed tomography (CT) scanner examination in the early diagnosis of complications in high-risk severely obese patients undergoing LSG is studied. METHODS This was a prospective, non-randomized study including all patients undergoing LSG in our department from 2014 to 2020. Patients presenting at least one potential risk factor for postoperative gastric leak and bleeding (as defined by the current literature) were included. Primary endpoint was the efficacy of postoperative day (POD) 2 CT-scanner examination in diagnosing these complications. RESULTS One thousand fifty-one high-risk patients were included. Median age was 44 years. Early postoperative surgical complications occurred in 48 patients (4.5%): 25 (2.3%) intraabdominal hemorrhage and 23 (2.2%) staple-line leak. Early CT-scanner detected intraabdominal bleeding or hematoma in 22/25 patients, with 95.6% sensitivity (Youden's index = 0.95), while specificity was 100%, positive predictive value (PPV) 100%, and negative predictive value (NPV) 99.9%. Sensitivity of early postoperative CT-scanner was 43.4% (10/23 patients; Youden's index = 0.43) for staple-line leak detection, with specificity of 100%, PPV 100%, and NPV 98.7%. CONCLUSION POD 2 CT-scanner in high-risk severely obese patients undergoing LSG is an excellent tool for early diagnosis of intraabdominal hemorrhage, but sensitivity remains low for staple-line leak detection. Close postoperative clinical follow-up of these patients is essential and any suspicion of postoperative surgical complication should motivate the performance of a CT-scanner.
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Affiliation(s)
- Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, AP-HP, F-92140, Clamart, France. .,Paris-Saclay University, F-91405, Orsay, France.
| | - Evangelia Triantafyllou
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, AP-HP, F-92140, Clamart, France
| | - Pierre Chagué
- Paris-Saclay University, F-91405, Orsay, France.,Department of Radiology, Antoine-Béclère Hospital, AP-HP, F-92140, Clamart, France
| | | | - Sophie Maitre
- Paris-Saclay University, F-91405, Orsay, France.,Department of Radiology, Antoine-Béclère Hospital, AP-HP, F-92140, Clamart, France
| | - Laurence Rocher
- Paris-Saclay University, F-91405, Orsay, France.,Department of Radiology, Antoine-Béclère Hospital, AP-HP, F-92140, Clamart, France
| | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, AP-HP, F-92140, Clamart, France.,Paris-Saclay University, F-91405, Orsay, France
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13
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The Relationship Between Tachycardia After Laparoscopic Sleeve Gastrectomy and the Development of Postoperative Complications. Obes Surg 2022; 32:1479-1485. [PMID: 35247161 DOI: 10.1007/s11695-022-05938-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 02/03/2022] [Accepted: 02/03/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Bariatric surgery can be associated with severe complications. Tachycardia is an important indicator of certain complications, such as anastomotic leak and hemorrhage. Our aim was to examine the relationship between tachycardia following sleeve gastrectomy and the appearance of associated complications. METHODS Patients who underwent sleeve gastrectomy over a 2-year period were included in the study. Participants were divided into two groups: the first included patients who suffered from postoperative tachycardia and the second patients with normal postoperative heart rates. Complications in both groups were examined. Other parameters that predict the onset of complications were also reviewed. RESULTS A total of 457 patients were included. Postoperative tachycardia was measured in 181 (39.6%) patients; 17 (3.7%) suffered from bleeding and 4 (1%) from staple line leakage. Postoperative bleeding was more common among patients with tachycardia than among those without (14 (7.7%) vs. 3 (1.1%), respectively). Patients in the tachycardia group had more staple line leakages than those in the normal heart rate group (3 (2%) vs. 1 (0%), respectively); tachycardia was also attributed to postoperative pain or other minor complications in 160 (88%) patients. Age ≥ 40 years was found to be predictive factor for postoperative complications. CONCLUSIONS The most common causes of tachycardia postoperatively were pain and minor complications. Tachycardia is an essential indicator of postoperative minor and major complications, mainly staple line leakage and bleeding. This should prompt immediate medical intervention in order to avoid serious adverse events.
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Martines G, Tomasicchio G, Picciariello A, Dibra R, Trigiante G, Lantone G, Altomare DF. Staple line reinforcement with nebulized cyanoacrylate glue in laparoscopic sleeve gastrectomy: A propensity score-matched study. Open Med (Wars) 2022; 17:197-204. [PMID: 35111973 PMCID: PMC8772997 DOI: 10.1515/med-2022-0426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 12/29/2022] Open
Abstract
Background A dreaded complication of laparoscopic sleeve gastrectomy (LSG) is suture leak. The study aimed to assess the efficacy of the nebulized comonomer Glubran 2® (N-butyl-cyanoacrylate + metacrylosysolfolane) applied to the LSG staple line. Methods A propensity-matched comparison analysis was conducted in 125 patients undergoing LSG between 2017 and 2019. Groups included those treated with Glubran® (group 1, n = 70) and those without Glubran® treatment (group 2, n = 55). Results There were differences in the mean body mass index (44.4 vs 43 kg/m2; P < 0.05) between the groups. There was a non-significant increase in the operative time for group 1 compared with group 2 (97 ± 8 vs 93.8 ± 10.7 min; P = 0.07), with a greater amount of estimated blood loss (94.5 mL vs 87.8; P < 0.01). There were more severe complications in group 2 over group 1 cases (8 vs 0%; P < 0.05), although postoperative bleeding did not differ between the two groups (1.4 vs 5.4%). There were no postoperative leaks in group 1 patients, but there were two leaks in group 2 cases with an increased length of hospital stay in patients with a leak. Conclusion Glubran® LSG support may reduce leak risk without increasing operating time.
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Affiliation(s)
- Gennaro Martines
- Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, Piazza Giulio Cesare, 11, Bari, Puglia, Italy
| | - Giovanni Tomasicchio
- Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, Piazza Giulio Cesare, 11, Bari, Puglia, Italy
| | - Arcangelo Picciariello
- Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, Piazza Giulio Cesare, 11, Bari, Puglia, Italy
| | - Rigers Dibra
- Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, Piazza Giulio Cesare, 11, Bari, Puglia, Italy
| | - Giuseppe Trigiante
- Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, Piazza Giulio Cesare, 11, Bari, Puglia, Italy
| | - Giuliano Lantone
- Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, Piazza Giulio Cesare, 11, Bari, Puglia, Italy
| | - Donato Francesco Altomare
- Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, Piazza Giulio Cesare, 11, Bari, Puglia, Italy
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