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Aloulou M, Martinino A, Alhejazi TJ, Pouwels S, Ahmed A, Byrne J, Parmar C. Sleeve Migration Following Sleeve Gastrectomy: A Systematic Review of Current Literature. Obes Surg 2024; 34:2237-2247. [PMID: 38703242 DOI: 10.1007/s11695-024-07259-5] [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: 03/04/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/06/2024]
Abstract
Sleeve gastrectomy (SG) is the most frequently performed bariatric procedure worldwide. The incidence and consequences of sleeve migration (SM) are not clearly understood. There is no clear consensus on appropriate measures to reduce the risk of SM. This study systematically reviewed the literature and identified 405 cases of SM from 21 studies. Age ranged from 18 to 68 years. Thirty-two percent and 11% of patients were females and males respectively, while sex was not reported in 57%. Time to diagnosis ranged from 1 day to 5 years postoperatively. A total of 9.6% and 58.8% of patients had or had no previous hiatal hernia respectively. SM incidence, risk factors, proposed mechanisms, clinical presentation, diagnosis, management, and potential preventive strategies are described in this review.
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Affiliation(s)
- Mohammad Aloulou
- Department of Surgery, Faculty of Medicine, University of Aleppo, Aleppo, Syria.
- Nabd Alhayat Medical Center, Aleppo, Syria.
| | | | | | - Sjaak Pouwels
- Departments of Surgery, Marien Hospital Herne, University Hospital of the Ruhr University Bochum, Herne, Germany
| | - Ahmed Ahmed
- Department of Surgery, Imperial College London, London, UK
| | - James Byrne
- Department of Surgery, University Hospital Southampton, Southampton, UK
| | - Chetan Parmar
- Department of Surgery, Whittington Hospital, London, UK
- Apollo Hospitals Education and Research Foundation, Apollo Hospitals, Chennai, India
- University College London, London, UK
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Elsherif SB, Sharma SK, Sharma S, Zulia Y, Kumar S, Sharma S. Acute incarcerated intrathoracic sleeve herniation after laparoscopic sleeve gastrectomy: an uncommon yet urgent complication-a comprehensive case report and literature review. Emerg Radiol 2023; 30:811-816. [PMID: 37934315 DOI: 10.1007/s10140-023-02182-1] [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: 09/30/2023] [Accepted: 10/27/2023] [Indexed: 11/08/2023]
Abstract
Laparoscopic sleeve gastrectomy (LSG) stands as one of the most frequently performed bariatric procedures in the USA. While hiatal hernia or intrathoracic migration of the staple line is frequently described as a chronic complication, this review article sheds light on the seldom-discussed acute presentation of this alarming complication. We present a compelling case of a young female who experienced sudden and intractable vomiting shortly after LSG. Utilizing a multidisciplinary approach, upper gastrointestinal imaging (UGI) and computed tomography (CT) scans unequivocally confirmed incarcerated intrathoracic migration of the gastric sleeve, necessitating immediate surgical intervention. Radiologists must be equipped with the knowledge to recognize subtle yet crucial imaging findings from UGI and CT scans to ensure timely intervention, thus mitigating the risks associated with this underreported acute complication of LSG and ultimately improving patient outcomes and safety.
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Affiliation(s)
- Sherif B Elsherif
- The Department of Radiology, The University of Florida College of Medicine, 2nd Floor, Clinical Center, 655 West 8th Street, C90, Jacksonville, FL, 33209, USA.
| | - Sunil K Sharma
- The Department of General Surgery, Ascension St. Vincent's Southside Hospital, Jacksonville, FL, USA
| | - Swati Sharma
- The Department of Radiology, The University of Florida College of Medicine, 2nd Floor, Clinical Center, 655 West 8th Street, C90, Jacksonville, FL, 33209, USA
| | - Yanni Zulia
- The Department of Radiology, The University of Florida College of Medicine, 2nd Floor, Clinical Center, 655 West 8th Street, C90, Jacksonville, FL, 33209, USA
| | - Sindhu Kumar
- The Department of Radiology, The University of Florida College of Medicine, 2nd Floor, Clinical Center, 655 West 8th Street, C90, Jacksonville, FL, 33209, USA
| | - Smita Sharma
- The Department of Radiology, The University of Florida College of Medicine, 2nd Floor, Clinical Center, 655 West 8th Street, C90, Jacksonville, FL, 33209, USA
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Dalkılıç MS, Erdem H, Gençtürk M, Yılmaz M, Sisik A. Acute Intrathoracic Migration With Incarceration of Laparoscopic Sleeve Gastrectomy Due to Incomplete Hiatal Hernia Repair. Cureus 2022; 14:e31362. [DOI: 10.7759/cureus.31362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 11/13/2022] Open
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Sabry K, Elmaleh HM, El-Swaify ST, Refaat MA, Atiya MAN, Alazab E, El-Abbassy I. Surgical Management Algorithm for Intrathoracic Sleeve Migration: A Retrospective Series and Literature Review. J Laparoendosc Adv Surg Tech A 2022; 32:1078-1091. [PMID: 36074085 DOI: 10.1089/lap.2022.0298] [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: 11/12/2022] Open
Abstract
Background: With the increase in utilization of laparoscopic sleeve gastrectomy (LSG), intrathoracic sleeve migration (ITSM) has introduced a novel challenge for bariatric surgeons. Despite being an underreported complication, effective and safe solutions for ITSM are being sought. The aim of this study is to present our center's experience as well as a comprehensive review of the literature on ITSM. Accordingly, we propose an algorithm for the surgical management of ITSM. Methods: We conducted a retrospective chart review of 4000 patients who underwent LSG at our center. ITSM was clinically suspected with gastroesophageal reflux disease (GERD) symptoms and/or epigastric pain resistant to proton pump inhibitors. Diagnosis of ITSM was confirmed in all patients by three-dimensional computed tomography (3D-CT) volumetry. Several corrective procedures were offered based on the findings of the 3D-CT volumetry, esophagogastroduodenoscopy, and the diaphragmatic pillars' condition: cruroplasty with gastropexy, one anastomosis gastric bypass (OAGB), or Roux-en-Y gastric bypass (RYGB) with or without re-sleeve gastrectomy, omentopexy, or ligamentum teres augmentation. We conducted a literature review of ITSM using several databases. Results: Fifteen patients were diagnosed with postoperative ITSM. The most common presenting complaint was severely worsened GERD symptoms not responding to medical treatment. The mean time interval between the primary operation and diagnosis of ITSM was 38.8 ± 29.1 months. Three patients had re-sleeve gastrectomy and gastropexy, 5 patients had OAGB, and 7 patients had RYGB. The mean postoperative body mass index was 31.2 ± 4.9 kg/m2. No case of recurrent ITSM was detected during follow-up. Our electronic database search yielded 19 studies to be included in our review, which included 201 patients. Conclusion: A high index of suspicion is required to diagnose ITSM. CT volumetry with 3D reconstruction may be the most sensitive diagnostic modality. ITSM management should depend on the results of the diagnostic workup and the condition of the diaphragmatic pillars during surgery.
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Affiliation(s)
- Karim Sabry
- Division of Bariatric Surgery, Ain Shams University Hospitals, Cairo, Egypt
| | | | | | - Mazen A Refaat
- Department of Surgery, Ain Shams University Hospitals, Cairo, Egypt
| | | | - Emad Alazab
- Department of Surgery, Ain Shams University Hospitals, Cairo, Egypt
| | - Islam El-Abbassy
- Division of Bariatric Surgery, Ain Shams University Hospitals, Cairo, Egypt.,Department of Surgery, Raigmore Hospital, Inverness, United Kingdom.,Institute of Medical Sciences, King's College, University of Aberdeen, Aberdeen, United Kingdom
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