Çalikoğlu İ, Özgen G, Yerdel MA. Inadvertent stapling of the orogastric tube during bariatric surgery: Report of 3 cases and a systematic review.
Medicine (Baltimore) 2021;
100:e24144. [PMID:
33466188 PMCID:
PMC7808471 DOI:
10.1097/md.0000000000024144]
[Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/07/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND
Entrapment of an orally introduced tube by stapling/stitching is an intra-operative complication of bariatric surgery with grave consequences. Incidence is unknown. No prevention/management strategy is available. A systematic review was performed to assess the absolute reported observed risk and incidence. Additionally, data on 3 cases during our entire sleeve gastrectomy (SG) experience is evaluated.
METHODS
Literature is reviewed using PubMed/Web of science data-bases. Data was recorded prospectively. Videos of orally introduced tube staplings were re-watched, presentation/recognition/management were re-evaluated. A protocol ensuring the removal of the small caliber orogastric tube (OGT) by the surgeons direct inspection was introduced after the 3rd entrapment.
RESULTS
Review revealed OGT as the most commonly entrapped tube following temperature probe and bougie. SG/stapling were the most common causative operation/reason, respectively. Leak rates over 20%, conversion, early-late re-operations and mortality were reported. During our 948 consecutive SGs, 3 OGT entrapments (0.32%), third one with double stapling, occurred. All were recognized/managed intraoperatively by freeing the entrapped-end of the OGT from the sleeve part of the staple-line. In doubly stapled case, second transected end could only be recognized when routine reinforcement suturing come in proximity. Defects were continuously stitched with barbed suture. No morbidity occurred. One-year excess-weight-loss was 82%. A pre-protocol incidence of 0.56% (n: 3/534) dropped to nil in the remaining 414.
CONCLUSION
Iatrogenic stapling of the OGT during SG is rare, but morbid. It must be avoided by a strict protocol. Upon occurrence/recognition, stapling must immediately stop until the "entirety" of the tube, including the "specimen-part", is retrieved, to avoid double entrapment.
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