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Mousavimaleki A, Amr B, Taherzadeh M, Rokhgireh S, Setaredan SA, Kermansaravi M. Post-Bariatric Splenic Complications; Diagnosis and Treatment. A Systematic Review. Obes Surg 2022; 32:3125-3137. [PMID: 35778627 DOI: 10.1007/s11695-022-06190-x] [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: 05/21/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 10/17/2022]
Abstract
This systematic review intends to evaluate incidence and symptoms of post-bariatric splenic complications as well as best available modalities establishing the diagnosis and management protocols. A systematic literature search was performed in electronic database until March 2022. A total of 41 articles were included on the subject of splenic complications following bariatric/metabolic surgery (BMS). Splenic abscess was the most common splenic complications (44.2%) after BMS and leak was the most common reported etiology of the splenic abscess. Fever and abdominal pain were the most common presenting symptom in all splenic complications and CT scan was the most common diagnostic modality. Splenic complications after BMS are relatively rare but may lead to dangerous consequences. Prompt diagnosis and treatment can prevent potentially life-threatening outcomes.
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Affiliation(s)
- Ali Mousavimaleki
- Minimally Invasive Surgery Research Center, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Bassem Amr
- Taunton and Somerset Foundation Trust, Taunton, UK
| | - Mahsa Taherzadeh
- Minimally Invasive Surgery Research Center, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Samaneh Rokhgireh
- Endometriosis Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Amin Setaredan
- Minimally Invasive Surgery Research Center, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, School of Medicine, Tehran, Iran. .,Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-e Rasool Hospital, Tehran, Iran.
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Laopeamthong I, Akethanin T, Kasetsermwiriya W, Techapongsatorn S, Tansawet A. Vacuum Therapy and Internal Drainage as the First-Line Endoscopic Treatment for Post-Bariatric Leaks: A Systematic Review and Meta-Analysis. Visc Med 2022; 38:63-71. [PMID: 35295893 PMCID: PMC8874239 DOI: 10.1159/000518946] [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: 05/04/2021] [Accepted: 08/06/2021] [Indexed: 02/03/2023] Open
Abstract
Introduction Several endoscopic methods can be employed to manage post-bariatric leaks. However, endoluminal vacuum therapy (EVT) and endoscopic internal drainage (EID) are relatively new methods, and studies regarding these methods are scarce. We performed a systematic review of the literature and a meta-analysis to evaluate the efficacy of EVT and EID. Methods Databases were searched for eligible studies. The clinical success of leak closure was the primary outcome of interest. A proportional meta-analysis was performed for pooling the primary outcome using a fixed-effects model. A meta-analysis or descriptive analysis of other outcomes was performed based on the data availability. Results Data from 3 EVT and 10 EID studies (n = 279) were used for evidence synthesis. The leak closure rates (95% confidence interval [CI]) of EVT and EID were 85.2% (75.1%-95.4%) and 91.6% (88.1%-95.2%), respectively. The corresponding mean treatment durations (95% CI) were 28 (2.4-53.6) and 78.4 (50.1-106.7) days, respectively. However, data about other outcomes were extremely limited; thus, a pooled analysis could not be performed. Conclusions Both EVT and EID were effective when used as the first-line treatment for post-bariatric leaks. However, larger studies must be conducted to compare the efficacy of the 2 interventions.
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Affiliation(s)
- Issaree Laopeamthong
- Vajira Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | | | - Wisit Kasetsermwiriya
- Vajira Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Suphakarn Techapongsatorn
- Vajira Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Amarit Tansawet
- Vajira Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand,*Amarit Tansawet,
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Buksh MM, Tallowin S, Al Samaraee A. Splenic Abscess Complicating Bariatric Surgery : A Systematic Review. Am Surg 2021; 88:28-37. [PMID: 33703937 DOI: 10.1177/0003134821991971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Bariatric surgery has become one of the most rapidly growing subspecialty performed globally, and it has been well reported to be associated with low morbidity and mortality rates. Splenic abscess is a rare but serious complication of bariatric surgery that has not been previously systematically reviewed in the literature. METHODS The authors have performed a systematic review of the evidence that has looked into the pathophysiology, clinical presentation, and the management options of splenic abscess complicating bariatric surgery. RESULTS This systematic review has been unsurprisingly based on level-IV evidence due to the rarity of the explored condition. The final analysis included 27 relevant reported cases. The mean age was 38 years and the mean of the time interval between the initial operation and developing splenic abscess was 72 days, with the male to female ratio being 1:1.6. Laparoscopic sleeve gastrectomy was the initial operation in 85.2% of the patients. Nearly half of the patients did not have an objective evidence of local or systemic sepsis that could explain the abscess formation. Nonsurgical management was attempted in 14 patients, with 34% success rate only. Splenectomy was needed in 41.7% of the patients. No mortality was reported. CONCLUSIONS Splenic abscess is a rare and rather late but serious complication of bariatric surgery that could result in splenectomy in a relatively young group of patients. It is more commonly reported following laparoscopic sleeve gastrectomy. Early diagnosis with intervention in a timely manner is crucial to avoid life threatening complications.
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Affiliation(s)
| | - Simon Tallowin
- Ashford and St. Peter`s NHS Foundation Trust, Surrey, UK
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Laparoscopic wedge resection of the proximal sleeve and handsewn esophago-sleeve anastomosis for repair of complicated staple line leak. Surg Obes Relat Dis 2020; 16:1621-1622. [PMID: 32753303 DOI: 10.1016/j.soard.2020.06.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/13/2020] [Accepted: 06/16/2020] [Indexed: 11/21/2022]
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Endoscopic internal drainage by double pigtail stents in the management of laparoscopic sleeve gastrectomy leaks. Surg Obes Relat Dis 2020; 16:831-838. [DOI: 10.1016/j.soard.2020.03.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 12/17/2022]
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Vedantam S, Roberts J. Endoscopic Stents in the Management of Bariatric Complications: Our Algorithm and Outcomes. Obes Surg 2019; 30:1150-1158. [DOI: 10.1007/s11695-019-04284-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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A Complication of an Endoscopic Pigtail Stent Migration into the Cavity during Deployment as a Treatment for Gastric Leak. Case Rep Surg 2019; 2019:6974527. [PMID: 31583156 PMCID: PMC6754919 DOI: 10.1155/2019/6974527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022] Open
Abstract
Gastric leak following gastrointestinal surgery is the most dreadful complication, which implies long hospital stay, morbidities, and not irrelevant mortalities. There is no standard recommendation for treating postlaparoscopic sleeve gastrectomy leak, which makes its management challenging. Endoscopic internal drainage by double-pigtail drains currently became the recommended approach. Complications to this approach include bleeding, ulceration at the tip of the double-pigtail stent, and uncommon migration. Here, we report our experience with drain displacement into the cavity while deployment in a patient who experienced gastric leakage after undergoing sleeve gastrectomy.
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Gastric leak after laparoscopic sleeve gastrectomy: management with endoscopic double pigtail drainage. A systematic review. Surg Obes Relat Dis 2019; 15:1414-1419. [PMID: 31023576 DOI: 10.1016/j.soard.2019.03.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 02/26/2019] [Accepted: 03/13/2019] [Indexed: 01/28/2023]
Abstract
Gastric leak remains the main complication after sleeve gastrectomy, but there are no standardized guidelines for its treatment. Good results have been reported using endoscopic double-pigtail stent. To estimate its effectiveness, we carried out this systematic review. Eleven eligible articles were identified by searching PubMed, Embase, and Cochrane Library databases. A total of 385 patients met the inclusion criteria. The pooled proportion of successful leak closures by using double pigtail drainage was 83.41%. The proportion of successful leak closures by using double pigtail drainage by experienced operators as first-line treatment was 84.71%. Our review suggested that double-pigtail stent could be a valid approach to manage the postbariatric gastric leak, with low rate of complications and a good tolerance by patients. More high-quality studies with large samples sizes should be undertaken to better evaluate and compare the variety of techniques available.
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Massive Gastrointestinal Bleeding Due to Splenic Artery Erosion by a PigTail Drain in a Post Sleeve Gastrectomy Leak: a Case Report. Obes Surg 2019; 29:1653-1656. [PMID: 30747387 DOI: 10.1007/s11695-019-03765-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Marchese M, Romano L, Giuliani A, Cianca G, Di Sibio A, Carlei F, Amicucci G, Schietroma M. A case of intrasplenic displacement of an endoscopic double-pigtail stent as a treatment for laparoscopic sleeve gastrectomy leak. Int J Surg Case Rep 2018; 53:367-369. [PMID: 30472633 PMCID: PMC6257903 DOI: 10.1016/j.ijscr.2018.11.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 10/31/2018] [Accepted: 11/08/2018] [Indexed: 12/11/2022] Open
Abstract
The most frequent and severe complication after laparoscopic sleeve gastrectomy is gastric leak. The endoscopic placement of a double-pigtail drain across the leak has been proven to be effective and minimally invasive. Drain’s migration into the abdominal cavity is not common and its intrasplenic displacement is even more rare. Pigtail drain migration involving the spleen may expose the patient to the risk of parenchymal abscess or haemorrhage.
Introduction The most frequent and severe complication after laparoscopic sleeve gastrectomy is gastric leak. Nowadays, there is no specific standard recommendation for its management, but the endoscopic placement of a double-pigtail drain across the leak has been proven to be effective and minimally invasive. Stent displacement into the abdominal cavity is not common and intrasplenic migration is even more rare. Case presentation We report a case of a 49-year-old woman with intrasplenic displacement of an endoscopic double-pigtail stent as a treatment for laparoscopic sleeve gastrectomy leak. Discussion Pigtail drain migration involving the spleen is rare but may potentially expose the patient to the risk of parenchymal abscess or haemorrhage. Often the clinic does not indicate early this complication. Conclusion We underline the need for a close radiologic follow-up, regardless of clinical conditions, in all patients treated with double-pigtail drain and its early removal in case of migration.
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Affiliation(s)
| | - Lucia Romano
- Department of Surgery, University of L'Aquila, L'Aquila, Italy.
| | | | - Giovanni Cianca
- Department of Surgery, University of L'Aquila, L'Aquila, Italy
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Shehab H. Enteral stents in the management of post-bariatric surgery leaks. Surg Obes Relat Dis 2017; 14:393-403. [PMID: 29428690 DOI: 10.1016/j.soard.2017.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 12/10/2017] [Accepted: 12/13/2017] [Indexed: 02/07/2023]
Abstract
A post-bariatric surgery leak is a rare but grave condition and remains every bariatric surgeon's nightmare. Endoscopic therapy with the insertion of self-expandable stents provides an effective minimally invasive approach for the management of leaks. Self-expandable stents, however, are still hampered by their tendency for migration and are not always well tolerated. Recently, double-pigtail stents have been proposed as an alternative endoscopic therapeutic modality. Both types of stents have been shown to be very effective in the management of leaks; however, most studies have pooled gastrointestinal leaks due to different etiologies together. In this article, we review the current status and foreseen innovations in gastrointestinal stenting for post-bariatric surgery leaks.
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Affiliation(s)
- Hany Shehab
- Gastrointestinal Endoscopy unit, Department of Gastroenterology, Cairo University, Cairo, Egypt.
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Debs T, Petrucciani N, Kassir R, Vanbiervliet G, Ben Amor I, Staccini AM, Sejor E, Gugenheim J. Migration of an Endoscopic Double Pigtail Drain into the Abdominal Wall Placed as a Treatment of a Fistula Post Revisional Bariatric Surgery. Obes Surg 2017; 27:1335-1337. [PMID: 28303506 DOI: 10.1007/s11695-017-2580-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Tarek Debs
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France.
| | - Niccolo Petrucciani
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
| | - Radwan Kassir
- Department of General Surgery, CHU Nord Hospital, Jean Monnet University, Saint-Etienne, France
| | - Geoffrey Vanbiervliet
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
| | - Imed Ben Amor
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
| | - Aline Myx Staccini
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
| | - Eric Sejor
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
| | - Jean Gugenheim
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
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