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Salas-Parra RD, Smolkin C, Choksi S, Pryor AD. Bariatric Surgery: Current Trends and Newer Surgeries. Gastrointest Endosc Clin N Am 2024; 34:609-626. [PMID: 39277294 DOI: 10.1016/j.giec.2024.06.005] [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: 09/17/2024]
Abstract
Bariatric surgery has evolved and gained in popularity as it has been recognized as the most sustainable and effective treatment for obesity and related diseases. These related diseases are significant causes of obesity related morbidity and mortality. Most bariatric procedures incorporate some component of gastric restriction with or without intestinal bypass, but the full mechanism of these procedures has yet to be elucidated. The most popular surgical procedure remains the sleeve gastrectomy over the last 10 years, while gastric bypass is also still commonly performed. We have also seen growth in revisional bariatric surgery and novel surgical procedures.
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Affiliation(s)
- Ruben D Salas-Parra
- Department of Surgery, Long Island Jewish Medical Center and North Shore University Hospital, Northwell, New Hyde Park, NY, USA
| | - Caroline Smolkin
- Department of Surgery, Long Island Jewish Medical Center and North Shore University Hospital, Northwell, New Hyde Park, NY, USA
| | - Sarah Choksi
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Aurora Dawn Pryor
- Long Island Jewish Medical Center, Northwell Health; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 240-05 76th Avenue, Suite B-241, New Hyde Park, NY 11040, USA.
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2
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Osti N, Aboud A, Gumbs S, Sabbagh R, Carryl S, Nazir S, Andrade J, McArthur K. Six-year analysis of 30-day post-operative leaks for primary sleeve gastrectomy: a MBSAQIP database study. Surg Endosc 2024:10.1007/s00464-024-11190-2. [PMID: 39218833 DOI: 10.1007/s00464-024-11190-2] [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: 04/23/2024] [Accepted: 08/17/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Sleeve gastrectomy is the most performed bariatric surgery. Post-operative gastric sleeve leaks, although rare, are dreaded complications. This study aims to perform an updated investigation of the factors associated with sleeve leaks. METHODS This retrospective cohort study analyzed 692,554 cases from the MBSAQIP database (2016-2021) with CPT code 43,775 for primary sleeve gastrectomy. We excluded emergency operations, conversions/revisions, endoscopic interventions, patient with prior foregut surgery, and open operations. Multivariate logistic regression analysis (STATA version 15) was performed to identify factors associated with sleeve gastrectomy leaks. RESULTS Out of 692,554 patients, 600,910 (86.77%) patients underwent laparoscopic sleeve gastrectomy, and 91,644 (13.23%) patients underwent robotic sleeve gastrectomy. 1179 (0.17%) developed leaks within 30 days; 177(0.19%) were in the robotic group and 1002 (0.17%) in the laparoscopic group with no significant difference in leak rates between two groups on multivariate analysis. Black patients had lower odds of having leaks as compared to white patients (Odds Ratio (OR): 0.68 (0.56-0.82); p < 0.01). Hispanic patients had lower odds of having leak as compared to non-Hispanics. Factors associated with higher leak odds (p < 0.05) included hypertension, GERD, smoking, immunosuppression, increased operating time, and albumin < 3.5 g/dl. Higher odds of leaks were observed in years 2016-2019 vs 2020-2021 (OR: 1.44 (1.25-1.65), p < 0.01). Higher odds of leak in operations with general surgeons compared to bariatric surgeons was found (OR: 1.46 (1.04-2.02), p = 0.02); observed only on robotic group on subgroup analysis (OR: 2.2 (1.2-4.2), p = 0.02). Staple line reinforcement, oversewing, and performance of leak test showed no differences in leak rate. Bougie size and distance from pylorus were not associated with changes in leak rate. CONCLUSION This study provides updated insights into the factors associated with sleeve leaks, reinforcing information gained from prior studies. A higher association of leak among general surgeons could represent a learning curve for new robotic general surgeons. The overall decreasing trend for gastric sleeve leak is encouraging and may be a sign of improved techniques.
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Affiliation(s)
- Narayan Osti
- Department of Surgery Harlem Hospital Center, NYC Health+Hospitals/Harlem, 506 Lenox Ave, MLK 12.107, New York, NY, 10037, USA.
| | - Ameer Aboud
- Department of Surgery Harlem Hospital Center, NYC Health+Hospitals/Harlem, 506 Lenox Ave, MLK 12.107, New York, NY, 10037, USA
| | - Shamon Gumbs
- Department of Surgery Harlem Hospital Center, NYC Health+Hospitals/Harlem, 506 Lenox Ave, MLK 12.107, New York, NY, 10037, USA
| | - Raja Sabbagh
- Department of Surgery Woodhull Medical Center, New York, USA
| | - Stephen Carryl
- Department of Surgery Harlem Hospital Center, NYC Health+Hospitals/Harlem, 506 Lenox Ave, MLK 12.107, New York, NY, 10037, USA
| | - Sharique Nazir
- Department of Surgery Harlem Hospital Center, NYC Health+Hospitals/Harlem, 506 Lenox Ave, MLK 12.107, New York, NY, 10037, USA
| | - Javier Andrade
- Department of Surgery Woodhull Medical Center, New York, USA
| | - Karina McArthur
- Department of Surgery Harlem Hospital Center, NYC Health+Hospitals/Harlem, 506 Lenox Ave, MLK 12.107, New York, NY, 10037, USA
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Jung CFM, Binda C, Tuccillo L, Secco M, Gibiino G, Liverani E, Petraroli C, Coluccio C, Fabbri C. New Endoscopic Devices and Techniques for the Management of Post-Sleeve Gastrectomy Fistula and Gastric Band Migration. J Clin Med 2024; 13:4877. [PMID: 39201020 PMCID: PMC11355382 DOI: 10.3390/jcm13164877] [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: 07/17/2024] [Revised: 08/14/2024] [Accepted: 08/15/2024] [Indexed: 09/02/2024] Open
Abstract
Post-sleeve gastrectomy fistulas are a rare but possibly severe life-threatening complication. Besides early reoperation and drainage, endoscopy is the main treatment option. According to the clinical setting, endoscopic treatment options comprise stent or clip placement. New endoscopic therapies have recently gained attention, including endoscopic vacuum therapy, VacStent therapy, endoscopic internal drainage with pigtail stents, endoscopic suturing and stem cell injection. In this narrative review, we shed light on recent literature, developments, indications and contraindications of these treatments. Intragastric gastric band migration is a rare complication after gastric band positioning. Reoperation can sometimes be difficult, especially when a gastric band has already migrated far into the stomach. Endoscopic retrieval can be a valid, non-invasive therapeutic solution. We reviewed the current literature on this matter.
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Affiliation(s)
- Carlo Felix Maria Jung
- Gastroenterology and Digestive Endoscopy Unit, Forli-Cesena Hospitals, AUSL Romagna, 47121 Forlì, Italy
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4
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Abu-Abeid A, Litmanovich A, Abu-Abeid S, Eldar SM, Lahat G, Yuval JB. Long-Term Outcomes of Patients with Staple Line Leaks Following Sleeve Gastrectomy. Obes Surg 2024; 34:2523-2529. [PMID: 38814413 PMCID: PMC11217129 DOI: 10.1007/s11695-024-07307-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE The long-term outcomes of patients with staple line leaks (SLL) after SG are under-reported. The purpose of this study is to evaluate the long-term outcomes of patients with SLL after SG. MATERIALS AND METHODS A retrospective analysis of a maintained patient registry of patients undergoing SG between January 2012 and December 2020 in a single bariatric center was analyzed and included patients with SLL. Outcomes were compared to a group without SLL. RESULTS During this period, 1985 patients underwent SG of which 61 patients (3.1%) developed leak. 26 patients (1.3%) had overt SLL and the rest had organ space infection around the staple line. The mean age and body mass index (BMI) were 39.8 ± 11.3 and 41.5 ± 4.7, respectively. 7 patients (11.4%) underwent concomitant surgery and 12 patients (19.7%) had intraoperative complications. Leak was complicated by Clavien-Dindo ≥ 3 in 31 patients (50.8%). Reoperation rate was 27.8% (n = 17). ≥ 2 interventions were required in 26% of patients (n = 16). Two patients died during hospitalization due to septic complications. Long-term follow-up of median 121 months was available in 78% of the cohort (n = 48). The median total weight loss and BMI were 27% and 30.1 kg/m2, respectively. Weight loss outcomes were higher in comparison to patients without SLL. Seven patients (14.6%) underwent SG revision. All associated medical problems improved during follow-up except for gastroesophageal reflux which was found in 50% of cohort. CONCLUSION Long-term outcomes of SG patients with SLL are satisfactory in terms of weight loss, resolution of comorbidities, and requirement for surgical revision.
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Affiliation(s)
- Adam Abu-Abeid
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, 6, Weizman St., 6423906, Tel- Aviv, Israel.
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman St., 6423906, Tel- Aviv, Israel.
- Tel Aviv University, The Faculty of Medical & Health Sciences, Tel- Aviv, Israel.
| | - Adi Litmanovich
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, 6, Weizman St., 6423906, Tel- Aviv, Israel
- Tel Aviv University, The Faculty of Medical & Health Sciences, Tel- Aviv, Israel
| | - Subhi Abu-Abeid
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, 6, Weizman St., 6423906, Tel- Aviv, Israel
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman St., 6423906, Tel- Aviv, Israel
- Tel Aviv University, The Faculty of Medical & Health Sciences, Tel- Aviv, Israel
| | - Shai Meron Eldar
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, 6, Weizman St., 6423906, Tel- Aviv, Israel
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman St., 6423906, Tel- Aviv, Israel
- Tel Aviv University, The Faculty of Medical & Health Sciences, Tel- Aviv, Israel
| | - Guy Lahat
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, 6, Weizman St., 6423906, Tel- Aviv, Israel
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman St., 6423906, Tel- Aviv, Israel
- Tel Aviv University, The Faculty of Medical & Health Sciences, Tel- Aviv, Israel
| | - Jonathan Benjamin Yuval
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, 6, Weizman St., 6423906, Tel- Aviv, Israel
- Tel Aviv University, The Faculty of Medical & Health Sciences, Tel- Aviv, Israel
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Kulinna-Cosentini C, Hodge JC, Ba-Ssalamah A. The role of radiology in diagnosing gastrointestinal tract perforation. Best Pract Res Clin Gastroenterol 2024; 70:101928. [PMID: 39053981 DOI: 10.1016/j.bpg.2024.101928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 05/05/2024] [Accepted: 06/04/2024] [Indexed: 07/27/2024]
Abstract
Spontaneous, iatrogenic or surgical perforation of the whole gastrointestinal wall can lead to serious complications, resulting in increased morbidity and mortality. Optimal patient management requires early clinical appraisal and prompt imaging evaluation. Both radiologists and referring clinicians should recognize the importance of choosing the ideal imaging modality and the usefulness of oral and rectal contrast medium. Surgeons and radiologists should be familiar with CT and fluoroscopy findings of the normal and pathologic anatomy after esophageal, stomach or colon surgery. Specifically, they should be able to differentiate innocuous from clinically-relevant, life-threatening postoperative complications to guide appropriate treatment. Advantages of esophagram, CT-esophagram, CT after rectal contrast enema and other imaging modalities are discussed.
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Affiliation(s)
| | - Jacqueline C Hodge
- Deaprtement of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria
| | - Ahmed Ba-Ssalamah
- Deaprtement of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria
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Coşkun M, Uprak TK, Günal Ö, Aliyeva A, Cingi A. Reinforcement in Laparoscopic Sleeve Gastrectomy: Is It Effective? Surg Laparosc Endosc Percutan Tech 2024; 34:290-294. [PMID: 38736400 DOI: 10.1097/sle.0000000000001283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 03/08/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Despite the success of bariatric surgery in treating obesity, it can still lead to complications. The most serious and feared technical complications are bleeding and leakage from the gastric staple line. In this study, stapler line reinforcement was investigated to determine whether it affects postoperative leakage and bleeding rates and their management. MATERIALS AND METHODS Overall, 510 patients who underwent sleeve gastrectomy were evaluated retrospectively. They were divided into 2 groups according to whether reinforcement of the staple line with running imbricating sutures was performed. RESULTS In the reinforcement group, there were two leaks (0.7%), which were diagnosed seven and eight days after surgery. In the non-reinforcement group, there were nine leaks (4%). There was no difference between the two groups in staple line bleeding. CONCLUSIONS This study shows that reinforcement with continuous imbricating sutures is associated with less stapler line leakage and a lower reoperation rate at the cost of increased operative time.
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Affiliation(s)
- Mümin Coşkun
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
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Wisniowski P, Samakar K, Cheng V, Hawley L, Abel S, Nguyen J, Dobrowolsky A, Martin M. Safety of redo sleeve gastrectomy as a primary revisional procedure. Surg Obes Relat Dis 2024:S1550-7289(24)00172-2. [PMID: 38871494 DOI: 10.1016/j.soard.2024.04.016] [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: 10/26/2023] [Revised: 04/01/2024] [Accepted: 04/26/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Insufficient weight loss after primary laparoscopic sleeve gastrectomy (LSG) occasionally requires revisional surgery. A few single-institution studies have examined the safety of redo LSG (RSG) and have shown mixed results. OBJECTIVES The aim of this study was to evaluate the safety of RSG compared with LSG over a period of 30 days. SETTING University of Southern California, United States; Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. METHODS The 2020-2021 MBSAQIP registry was used to evaluate patients who underwent RSG. Thirty-day outcomes were evaluated using univariable analysis and multivariable logistic and linear regression. RESULTS A total of 226,029 patients were reviewed, of whom 1454 (.7%) underwent RSG and 224,575 (99.3%) underwent initial LSG. Patients who underwent RSG were older (45 versus 42 yr), predominantly female (86.2% versus 81.3%), had a lower body mass index (40.0 versus 43.4), fewer co-morbidities, and greater rates of gastroesophageal reflux (38.7% versus 25.1%). They demonstrated increased overall complications (3.6% versus 2.1%, P < .001) and a longer operative time (81 versus 62 min, P < .001), but there was no difference in mortality. On multivariable analysis, patients who underwent RSG were independently associated with an increased risk of overall postoperative complications (odds ratio [OR]: 1.493, P = .018), organ space infection (OR: 6.231, P < .001), staple line leak (OR: 12.838, P < .001), pneumonia (OR: 3.85, P = .013), ventilator requirement over 48 hours (OR: 6.404, P = .035), sepsis (OR: 4.397, P = .010), septic shock (OR: 8.669, P < .001), reoperation (OR: 1.808, P = .013), readmission (OR: 2.104, P < .001), reintervention (OR: 4.435, P < .001), and longer operative times (β = 12.790, P < .001). CONCLUSIONS In this national database study, RSG was associated with increased rates of postoperative complications and a longer operative time. Although these results are concerning, further studies are required to examine long-term outcomes.
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Affiliation(s)
- Paul Wisniowski
- Division of Upper GI and General Surgery, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, California.
| | - Kamran Samakar
- Division of Upper GI and General Surgery, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
| | - Vincent Cheng
- Department of Bariatric Surgery, Kaiser Permanente South Sacramento Medical Center, Sacramento, California
| | - Lauren Hawley
- Division of Upper GI and General Surgery, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
| | - Stuart Abel
- Division of Upper GI and General Surgery, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
| | - James Nguyen
- Division of Upper GI and General Surgery, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
| | - Adrian Dobrowolsky
- Division of Upper GI and General Surgery, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
| | - Matthew Martin
- Division of Upper GI and General Surgery, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
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Graceffa P, Melatti P, Dioguardi A, Callari C, Cartabellotta F, Granata A. Hematic Peri-gastric Collection Post-LSG: What About Endoscopic Internal Drainage? Obes Surg 2024; 34:2001-2002. [PMID: 38499944 DOI: 10.1007/s11695-024-07166-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/07/2024] [Accepted: 03/07/2024] [Indexed: 03/20/2024]
Affiliation(s)
- Pietro Graceffa
- Interventional Endoscopic Unit, Buccheri La Ferla Hospital, Postal Code: 90123, Palermo, Italy.
| | - Piera Melatti
- Interventional Endoscopic Unit, Buccheri La Ferla Hospital, Postal Code: 90123, Palermo, Italy
| | - Angelo Dioguardi
- Center of Excellence in Bariatric Surgery, Buccheri La Ferla Hospital, Postal Code: 90123, Palermo, Italy
| | - Cosimo Callari
- Center of Excellence in Bariatric Surgery, Buccheri La Ferla Hospital, Postal Code: 90123, Palermo, Italy
| | - Fabio Cartabellotta
- Department of Internal Medicine, Buccheri La Ferla Hospital, Postal Code: 90123, Palermo, Italy
| | - Antonino Granata
- Interventional Endoscopic Unit, Buccheri La Ferla Hospital, Postal Code: 90123, Palermo, Italy
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Li S, Lu D, Li S, Liu J, Xu Y, Yan Y, Rodriguez JZ, Bai H, Avila R, Kang S, Ni X, Luan H, Guo H, Bai W, Wu C, Zhou X, Hu Z, Pet MA, Hammill CW, MacEwan MR, Ray WZ, Huang Y, Rogers JA. Bioresorbable, wireless, passive sensors for continuous pH measurements and early detection of gastric leakage. SCIENCE ADVANCES 2024; 10:eadj0268. [PMID: 38640247 PMCID: PMC11029800 DOI: 10.1126/sciadv.adj0268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 03/18/2024] [Indexed: 04/21/2024]
Abstract
Continuous monitoring of biomarkers at locations adjacent to targeted internal organs can provide actionable information about postoperative status beyond conventional diagnostic methods. As an example, changes in pH in the intra-abdominal space after gastric surgeries can serve as direct indicators of potentially life-threatening leakage events, in contrast to symptomatic reactions that may delay treatment. Here, we report a bioresorbable, wireless, passive sensor that addresses this clinical need, designed to locally monitor pH for early detection of gastric leakage. A pH-responsive hydrogel serves as a transducer that couples to a mechanically optimized inductor-capacitor circuit for wireless readout. This platform enables real-time monitoring of pH with fast response time (within 1 hour) over a clinically relevant period (up to 7 days) and timely detection of simulated gastric leaks in animal models. These concepts have broad potential applications for temporary sensing of relevant biomarkers during critical risk periods following diverse types of surgeries.
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Affiliation(s)
- Shuo Li
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Di Lu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- School of Microelectronics, University of Science and Technology of China, Hefei, Anhui 230026, China
| | - Shupeng Li
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Jiaqi Liu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Yameng Xu
- The Institute of Materials Science and Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Ying Yan
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jorge Zárate Rodriguez
- Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Hedan Bai
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Raudel Avila
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Shuming Kang
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Xinchen Ni
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Haiwen Luan
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Hexia Guo
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Wubin Bai
- Department of Applied Physical Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Changsheng Wu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, National University of Singapore, Singapore 117575, Singapore
| | - Xuhao Zhou
- Department of Chemistry, Northwestern University, Evanston, IL 60208, USA
| | - Ziying Hu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Mitchell A. Pet
- Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Chet W. Hammill
- Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Matthew R. MacEwan
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Wilson Z. Ray
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Yonggang Huang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL 60208, USA
| | - John A. Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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10
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Masood M, Low DE, Deal SB, Kozarek RA. Endoscopic Management of Post-Sleeve Gastrectomy Complications. J Clin Med 2024; 13:2011. [PMID: 38610776 PMCID: PMC11012813 DOI: 10.3390/jcm13072011] [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: 02/09/2024] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Obesity is associated with several chronic conditions including diabetes, cardiovascular disease, and metabolic dysfunction-associated steatotic liver disease and malignancy. Bariatric surgery, most commonly Roux-en-Y gastric bypass and sleeve gastrectomy, is an effective treatment modality for obesity and can improve associated comorbidities. Over the last 20 years, there has been an increase in the rate of bariatric surgeries associated with the growing obesity epidemic. Sleeve gastrectomy is the most widely performed bariatric surgery currently, and while it serves as a durable option for some patients, it is important to note that several complications, including sleeve leak, stenosis, chronic fistula, gastrointestinal hemorrhage, and gastroesophageal reflux disease, may occur. Endoscopic methods to manage post-sleeve gastrectomy complications are often considered due to the risks associated with a reoperation, and endoscopy plays a significant role in the diagnosis and management of post-sleeve gastrectomy complications. We perform a detailed review of the current endoscopic management of post-sleeve gastrectomy complications.
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Affiliation(s)
- Muaaz Masood
- Division of Gastroenterology and Hepatology, Center for Digestive Health, Virginia Mason Franciscan Health, Seattle, WA 98101, USA
| | - Donald E. Low
- Division of Thoracic Surgery, Center for Digestive Health, Virginia Mason Franciscan Health, Seattle, WA 98101, USA;
| | - Shanley B. Deal
- Division of General and Bariatric Surgery, Center for Weight Management, Virginia Mason Franciscan Health, Seattle, WA 98101, USA;
| | - Richard A. Kozarek
- Division of Gastroenterology and Hepatology, Center for Digestive Health, Virginia Mason Franciscan Health, Seattle, WA 98101, USA
- Center for Interventional Immunology, Benaroya Research Institute, Virginia Mason Franciscan Health, Seattle, WA 98101, USA
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Masood M, Low DE, Deal SB, Kozarek RA. Current Management and Treatment Paradigms of Gastroesophageal Reflux Disease following Sleeve Gastrectomy. J Clin Med 2024; 13:1246. [PMID: 38592683 PMCID: PMC10932325 DOI: 10.3390/jcm13051246] [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: 01/15/2024] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
Obesity is associated with serious comorbidities and economic implications. Bariatric surgery, most commonly Roux-en-Y gastric bypass and sleeve gastrectomy, are effective options for weight loss and the improvement of obesity-related comorbidities. With the growing obesity epidemic, there has been a concomitant rise in bariatric surgeries, particularly in sleeve gastrectomy, which has been the most widely performed bariatric surgery since 2013. Gastroesophageal reflux disease (GERD) is highly prevalent in obese individuals, can significantly impact quality of life and may lead to serious complications. Obesity and GERD both improve with weight loss. However, as the incidence of sleeve gastrectomy rises, recent data have revealed a risk of exacerbation of pre-existing GERD or the development of de novo GERD following sleeve gastrectomy. We performed a detailed review of GERD post-sleeve gastrectomy, including its overall incidence, pathophysiology and current treatment paradigms.
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Affiliation(s)
- Muaaz Masood
- Division of Gastroenterology and Hepatology, Center for Digestive Health, Virginia Mason Franciscan Health, Seattle, WA 98101, USA;
| | - Donald E. Low
- Division of Thoracic Surgery, Center for Digestive Health, Virginia Mason Franciscan Health, Seattle, WA 98101, USA;
| | - Shanley B. Deal
- Division of General and Bariatric Surgery, Center for Weight Management, Virginia Mason Franciscan Health, Seattle, WA 98101, USA;
| | - Richard A. Kozarek
- Division of Gastroenterology and Hepatology, Center for Digestive Health, Virginia Mason Franciscan Health, Seattle, WA 98101, USA;
- Center for Interventional Immunology, Benaroya Research Institute, Virginia Mason Franciscan Health, Seattle, WA 98101, USA
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Deffain A, Alfaris H, Hajjar R, Thibeault F, Dimassi W, Denis R, Garneau PY, Studer AS, Pescarus R. Long-term follow-up of a cohort with post sleeve gastrectomy leaks: results of endoscopic treatment and salvage surgery. Surg Endosc 2023; 37:9358-9365. [PMID: 37640954 DOI: 10.1007/s00464-023-10386-2] [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: 04/14/2023] [Accepted: 08/12/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Laparoscopic sleeve gastrectomy (LSG) is the most performed bariatric procedure worldwide. The most challenging postoperative complication is gastric leak. The objectives of this study are to examine the efficacy and morbidity of different therapeutic strategies addressing leakage, and the long-term outcomes of a cohort of LSG leaks. METHODS A retrospective review of patients treated for LSG leaks between September 2014 and January 2023 at our high-volume bariatric surgery center was performed. RESULTS The charts of 37 patients (29 women and 8 men) were reviewed, with a mean age of 43 years and a median follow-up of 24 months. The mean preoperative body mass index was 45.1 kg/m2. Overall, 30/37 (81%) patients were successfully treated with endoscopic management, and 7/37 (19%) ultimately underwent salvage surgery. If the leak was diagnosed earlier than 6 weeks, endoscopic treatment had a 97% success rate. The median number of endoscopic procedures was 2 per patient, and included internal pigtails, stents, septoplasty, endoluminal vacuum therapy and over-the-scope clips. Complications included stent-related ulcers (10), esophageal stenosis requiring endoscopic dilatations (4), stent migrations (2) and kinking requiring repositioning (1), and internal pigtail migration (3). Revisional surgery consisted of proximal gastrectomy and Roux-en-Y esophago-jejunal anastomosis, Roux-en-Y fistulo-jejunostomy or classic Roux-en-Y gastric bypass proximal to the gastric stricture. In 62% of the cases, the axis/caliber of the LSG was abnormal. Beyond 4 attempts, endoscopy was unsuccessful. The success rate of endoscopic management dropped to 25% when treatment was initiated more than 45 days after the index surgery. CONCLUSIONS Purely endoscopic management was successful in 81% of cases; with 97% success rate if diagnosis earlier than 6 weeks. After four failed endoscopic procedures, a surgical approach should be considered. Delayed diagnosis appears to be a significant risk factor for failure of endoscopic treatment.
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Affiliation(s)
| | | | - Roy Hajjar
- Hôpital du Sacré Coeur, Montreal, Canada
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13
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Sidhu TS, Jhamb S, Welch C, Whiting S. Minimally invasive management of sleeve gastrectomy collection with a nasobiliary drainage tube. J Surg Case Rep 2023; 2023:rjad626. [PMID: 38026737 PMCID: PMC10663060 DOI: 10.1093/jscr/rjad626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/29/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
A staple line leak is a feared complication of sleeve gastrectomy. Endoscopic methods have superseded surgical management of small leaks, however large collections often require surgical intervention. Here, we describe endoscopic management of large collection adjacent to the staple line with an 8Fr nasobiliary tube.
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Affiliation(s)
- Tejminder S Sidhu
- College of Medicine and Dentistry, James Cook University, James Cook Drive, QLD 4811, Queensland, Australia
- Department of Surgery, Townsville University Hospital, 100 Angus Smith Drive, Douglas QLD 4814, Townsville, Queensland, Australia
| | - Shaurya Jhamb
- College of Medicine and Dentistry, James Cook University, James Cook Drive, QLD 4811, Queensland, Australia
- Department of Surgery, Townsville University Hospital, 100 Angus Smith Drive, Douglas QLD 4814, Townsville, Queensland, Australia
| | - Christine Welch
- Gastroenterology North Queensland, Mater Hospital, 25 Fulham Road, Pimlico QLD 4812, Townsville, Queensland, Australia
| | - Scott Whiting
- Department of Surgery, Townsville University Hospital, 100 Angus Smith Drive, Douglas QLD 4814, Townsville, Queensland, Australia
- North Queensland Minimal Invasive Surgery (NQMIS), Mater Hospital, 25 Fulham Road, Pimlico QLD 4812, Townsville, Queensland, Australia
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14
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Marcolin P, Machado Berleze M, Polettini J, Marchesan Rodrigues MA, Augustin Silveira D. The Impact of Helicobacter pylori on Laparoscopic Sleeve Gastrectomy Postoperative Complications: a Systematic Review and Meta-analysis. Obes Surg 2023; 33:3649-3657. [PMID: 37798512 DOI: 10.1007/s11695-023-06858-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/13/2023] [Accepted: 09/24/2023] [Indexed: 10/07/2023]
Abstract
We aimed to assess the impact of Helicobacter pylori infection on postoperative outcomes following laparoscopic sleeve gastrectomy (LSG). We searched Cochrane, Scopus, and PubMed databases, reviewed 1026 studies, and thoroughly analyzed 42 of them. Our final analysis included 13 studies comprising 6199 patients. We found that H. pylori infection was correlated with higher rates of risk of overall postoperative complications (OR 1.56; 95% CI 1.13, 2.16; P = 0.007) and staple line leak (OR 1.89; 95% CI 1.05, 3.41; P = 0.03). There were no significant differences in hospital length of stay or postoperative bleeding rates. Despite observed correlations between H. pylori positivity in gastric specimen and postoperative complications in LSG, definitive causation remains elusive, emphasizing the need for prospective randomized studies evaluating the effect of preoperative H. pylori screening and eradication.
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Affiliation(s)
- Patrícia Marcolin
- Universidade Federal da Fronteira Sul (UFFS), Rua Capitão Araújo, 20, Passo Fundo, RS, 99010121, Brazil
| | - Matheus Machado Berleze
- Universidade Federal da Fronteira Sul (UFFS), Rua Capitão Araújo, 20, Passo Fundo, RS, 99010121, Brazil.
| | - Jossimara Polettini
- Universidade Federal da Fronteira Sul (UFFS), Rua Capitão Araújo, 20, Passo Fundo, RS, 99010121, Brazil
| | - Maria A Marchesan Rodrigues
- Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Avenida Professor Mário Rubens Guimarães Montenegro, S/N, Botucatu, SP, 18618687, Brazil
| | - Daniela Augustin Silveira
- Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Avenida Professor Mário Rubens Guimarães Montenegro, S/N, Botucatu, SP, 18618687, Brazil
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15
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Medas R, Rodrigues-Pinto E. Endoscopic treatment of upper gastrointestinal postsurgical leaks: a narrative review. Clin Endosc 2023; 56:693-705. [PMID: 37430398 PMCID: PMC10665610 DOI: 10.5946/ce.2023.043] [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] [Received: 01/28/2023] [Revised: 03/28/2023] [Accepted: 04/01/2023] [Indexed: 07/12/2023] Open
Abstract
Upper gastrointestinal postsurgical leaks are life-threatening conditions with high mortality rates and are one of the most feared complications of surgery. Leaks are challenging to manage and often require radiological, endoscopic, or surgical intervention. Steady advancements in interventional endoscopy in recent decades have allowed the development of new endoscopic devices and techniques that provide a more effective and minimally invasive therapeutic option compared to surgery. Since there is no consensus regarding the most appropriate therapeutic approach for managing postsurgical leaks, this review aimed to summarize the best available current data. Our discussion specifically focuses on leak diagnosis, treatment aims, comparative endoscopic technique outcomes, and combined multimodality approach efficacy.
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Affiliation(s)
- Renato Medas
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Eduardo Rodrigues-Pinto
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
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16
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Suter B, Anthis AHC, Zehnder A, Mergen V, Rosendorf J, Gerken LRH, Schlegel AA, Korcakova E, Liska V, Herrmann IK. Surgical Sealant with Integrated Shape-Morphing Dual Modality Ultrasound and Computed Tomography Sensors for Gastric Leak Detection. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2301207. [PMID: 37276437 PMCID: PMC10427398 DOI: 10.1002/advs.202301207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/26/2023] [Indexed: 06/07/2023]
Abstract
Postoperative anastomotic leaks are the most feared complications after gastric surgery. For diagnostics clinicians mostly rely on clinical symptoms such as fever and tachycardia, often developing as a result of an already fully developed, i.e., symptomatic, surgical leak. A gastric fluid responsive, dual modality, electronic-free, leak sensor system integrable into surgical adhesive suture support materials is introduced. Leak sensors contain high atomic number carbonates embedded in a polyacrylamide matrix, that upon exposure to gastric fluid convert into gaseous carbon dioxide (CO2 ). CO2 bubbles remain entrapped in the hydrogel matrix, leading to a distinctly increased echogenic contrast detectable by a low-cost and portable ultrasound transducer, while the dissolution of the carbonate species and the resulting diffusion of the cation produces a markedly reduced contrast in computed tomography imaging. The sensing elements can be patterned into a variety of characteristic shapes and can be combined with nonreactive tantalum oxide reference elements, allowing the design of shape-morphing sensing elements visible to the naked eye as well as artificial intelligence-assisted automated detection. In summary, shape-morphing dual modality sensors for the early and robust detection of postoperative complications at deep tissue sites, opening new routes for postoperative patient surveillance using existing hospital infrastructure is reported.
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Affiliation(s)
- Benjamin Suter
- Nanoparticle Systems Engineering LaboratoryInstitute of Energy and Process Engineering (IEPE)Department of Mechanical and Process Engineering (D‐MAVT)ETH ZurichSonneggstrasse 3Zürich8092Switzerland
- Particles‐Biology InteractionsDepartment of Materials Meet LifeSwiss Federal Laboratories for Materials Science and Technology (Empa)Lerchenfeldstrasse 5St. Gallen9014Switzerland
| | - Alexandre H. C. Anthis
- Nanoparticle Systems Engineering LaboratoryInstitute of Energy and Process Engineering (IEPE)Department of Mechanical and Process Engineering (D‐MAVT)ETH ZurichSonneggstrasse 3Zürich8092Switzerland
- Particles‐Biology InteractionsDepartment of Materials Meet LifeSwiss Federal Laboratories for Materials Science and Technology (Empa)Lerchenfeldstrasse 5St. Gallen9014Switzerland
| | - Anna‐Katharina Zehnder
- Nanoparticle Systems Engineering LaboratoryInstitute of Energy and Process Engineering (IEPE)Department of Mechanical and Process Engineering (D‐MAVT)ETH ZurichSonneggstrasse 3Zürich8092Switzerland
| | - Victor Mergen
- Diagnostic and Interventional RadiologyUniversity Hospital ZurichUniversity of ZurichRämistrasse 100Zürich8091Switzerland
| | - Jachym Rosendorf
- Department of SurgeryFaculty of Medicine in PilsenCharles UniversityAlej Svobody 923/80Pilsen32300Czech Republic
- Biomedical CenterFaculty of Medicine in PilsenCharles UniversityAlej Svobody 1655/76Pilsen32300Czech Republic
| | - Lukas R. H. Gerken
- Nanoparticle Systems Engineering LaboratoryInstitute of Energy and Process Engineering (IEPE)Department of Mechanical and Process Engineering (D‐MAVT)ETH ZurichSonneggstrasse 3Zürich8092Switzerland
- Particles‐Biology InteractionsDepartment of Materials Meet LifeSwiss Federal Laboratories for Materials Science and Technology (Empa)Lerchenfeldstrasse 5St. Gallen9014Switzerland
| | - Andrea A. Schlegel
- Department of Surgery and TransplantationSwiss HPB CentreUniversity Hospital ZurichRämistrasse 100Zurich8091Switzerland
- Fondazione IRCCS Ca' GrandaOspedale Maggiore PoliclinicoCentre of Preclinical ResearchMilan20122Italy
- Transplantation Center, Digestive Disease and Surgery Institute and Department of Immunity and Inflammation, Lerner Research InstituteCleveland Clinic9620 Carnegie AveClevelandOH44106United States
| | - Eva Korcakova
- Biomedical CenterFaculty of Medicine in PilsenCharles UniversityAlej Svobody 1655/76Pilsen32300Czech Republic
- Department of Imaging MethodsFaculty of Medicine in Pilsen, Charles UniversityAlej Svobody 80Pilsen30460Czech Republic
| | - Vaclav Liska
- Department of SurgeryFaculty of Medicine in PilsenCharles UniversityAlej Svobody 923/80Pilsen32300Czech Republic
- Biomedical CenterFaculty of Medicine in PilsenCharles UniversityAlej Svobody 1655/76Pilsen32300Czech Republic
| | - Inge K. Herrmann
- Nanoparticle Systems Engineering LaboratoryInstitute of Energy and Process Engineering (IEPE)Department of Mechanical and Process Engineering (D‐MAVT)ETH ZurichSonneggstrasse 3Zürich8092Switzerland
- Particles‐Biology InteractionsDepartment of Materials Meet LifeSwiss Federal Laboratories for Materials Science and Technology (Empa)Lerchenfeldstrasse 5St. Gallen9014Switzerland
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17
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Medas R, Rodrigues-Pinto E. Technical Review on Endoscopic Treatment Devices for Management of Upper Gastrointestinal Postsurgical Leaks. Gastroenterol Res Pract 2023; 2023:9712555. [PMID: 37342388 PMCID: PMC10279499 DOI: 10.1155/2023/9712555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/20/2022] [Accepted: 11/25/2022] [Indexed: 06/22/2023] Open
Abstract
Upper gastrointestinal postsurgical leaks are challenging to manage and often require radiological, endoscopic, or surgical intervention. Nowadays, endoscopy is considered the first-line approach for their management, however, there is no definite consensus on the most appropriate therapeutic approach. There is a wide diversity of endoscopic options, from close-cover-divert approaches to active or passive internal drainage approaches. Theoretically, all these options can be used alone or with a multimodality approach, as each of them has different mechanisms of action. The approach to postsurgical leaks should always be tailored to each patient, taking into account the several variables that may influence the final outcome. In this review, we discuss the important developments in endoscopic devices for the treatment of postsurgical leaks. Our discussion specifically focuses on principles and mechanism of action, advantages and disadvantages of each technique, indications, clinical success, and adverse events. An algorithm for endoscopic approach is proposed.
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Affiliation(s)
- Renato Medas
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Eduardo Rodrigues-Pinto
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
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18
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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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19
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The Evolving Management of Leaks Following Sleeve Gastrectomy. CURRENT SURGERY REPORTS 2023. [DOI: 10.1007/s40137-023-00357-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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20
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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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21
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Binda C, Jung CFM, Fabbri S, Giuffrida P, Sbrancia M, Coluccio C, Gibiino G, Fabbri C. Endoscopic Management of Postoperative Esophageal and Upper GI Defects-A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59010136. [PMID: 36676760 PMCID: PMC9864982 DOI: 10.3390/medicina59010136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/27/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
Anastomotic defects are deleterious complications after either oncologic or bariatric surgery, leading to high morbidity and mortality. Besides surgical revision in early stages or instable patients, endoscopic treatment has become the mainstay. To date, many options for endoscopic treatment in this setting exist, including fully covered metal stent placement, endoscopic vacuum therapy (EVT), endoscopic internal drainage with pigtail placement (EID), leak closure with through the scope or over the scope clips, endoluminal suturing, fibrin glue sealing and a combination of all these techniques. Current evidence is mostly based on retrospective single and multicenter studies. No guidelines exist in this important field. Treatment options have to be chosen upon each case individually, taking into account clinical and anatomic criteria, such as timing, size, infectious wound complications and hemodynamic stability. Local expertise and availability of treatment devices need to be taken into account whenever choosing a treatment strategy. This review aimed to present current treatment options in terms of effectiveness, advantages and disadvantages in order to guide the clinician for his decision making. Additionally, we aimed to provide a treatment algorithm.
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Affiliation(s)
- Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forli—Cesena Hospitals, AUSL Romagna, 47121 Forlì Cesena, Italy
- Correspondence:
| | - Carlo Felix Maria Jung
- Gastroenterology and Digestive Endoscopy Unit, Forli—Cesena Hospitals, AUSL Romagna, 47121 Forlì Cesena, Italy
| | - Stefano Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forli—Cesena Hospitals, AUSL Romagna, 47121 Forlì Cesena, Italy
| | - Paolo Giuffrida
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, 90127 Palermo, Italy
| | - Monica Sbrancia
- Gastroenterology and Digestive Endoscopy Unit, Forli—Cesena Hospitals, AUSL Romagna, 47121 Forlì Cesena, Italy
| | - Chiara Coluccio
- Gastroenterology and Digestive Endoscopy Unit, Forli—Cesena Hospitals, AUSL Romagna, 47121 Forlì Cesena, Italy
| | - Giulia Gibiino
- Gastroenterology and Digestive Endoscopy Unit, Forli—Cesena Hospitals, AUSL Romagna, 47121 Forlì Cesena, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forli—Cesena Hospitals, AUSL Romagna, 47121 Forlì Cesena, Italy
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22
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Lainas P, Triantafyllou E, Ben Amor V, Savvala N, Gugenheim J, Dagher I, Amor IB. Laparoscopic Roux-en-Y fistulojejunostomy as a salvage procedure in patients with chronic gastric leak after sleeve gastrectomy. Surg Obes Relat Dis 2022; 19:585-592. [PMID: 36658084 DOI: 10.1016/j.soard.2022.12.017] [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: 04/12/2022] [Revised: 10/29/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The most common postoperative complication of laparoscopic sleeve gastrectomy (LSG) is staple-line leak. Even if its rate following LSG has been recently reduced, management of chronic leaks remains challenging. OBJECTIVE To present a series of patients treated with laparoscopic Roux-en-Y fistulojejunostomy (LRYFJ) for chronic gastric leak (>12 wk) post-LSG. SETTING University hospitals; specialized bariatric surgery units. METHODS Data were prospectively gathered and retrospectively analyzed. Parameters of interest were patient characteristics, perioperative data, and postoperative outcomes. Hemodynamically unstable patients and/or presentations of signs of severe sepsis were excluded. Surgical technique was standardized. RESULTS Fourteen patients underwent LRYFJ for chronic gastric leak (12 women, 2 men). The mean age was 49.2 years and the mean weight was 88.7 kg with a mean body mass index of 31.1 kg/m2. All procedures were successfully performed by laparoscopy except 1 (7.1%) converted to open surgery. The mean operative time was 198 minutes, with a mean estimated blood loss of 135.7 mL and 2 patients necessitating transfusion (14.2%). Mortality was null. Five postoperative complications were noted (35.7%): 2 leaks of the fistulojejunostomy treated by antibiotherapy and endoscopic drainage; 1 perianastomotic hematoma treated by relaparoscopy and antibiotherapy; and 1 pleural effusion and 1 hematemesis both medically treated. The mean length of hospital stay was 14 days. The mean follow-up was 40 months, with all patients being in good health at last contact. CONCLUSIONS LRYFJ seems to be a good salvage option in selected patients for the treatment of chronic gastric leaks after LSG. However, it is a challenging procedure and should be performed in experienced bariatric centers by expert bariatric surgeons.
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Affiliation(s)
- Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Clamart, France; Paris-Saclay University, Orsay, France; Department of Digestive Surgery, Metropolitan Hospital, HEAL Academy, Athens, Greece.
| | - Evangelia Triantafyllou
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Clamart, France
| | | | - Natalia Savvala
- Department of Digestive Surgery, Archet II Hospital, Nice, France
| | - Jean Gugenheim
- Department of Digestive Surgery, Archet II Hospital, Nice, France; University of Nice-Sophia-Antipolis, Nice, France; INSERM U1081, Nice, France
| | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Clamart, France; Paris-Saclay University, Orsay, France
| | - Imed Ben Amor
- Department of Digestive Surgery, Archet II Hospital, Nice, France; University of Nice-Sophia-Antipolis, Nice, France; INSERM U1081, Nice, France
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23
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Silverman JR. Obesity, Bariatric Surgery, and Postoperative Nutritional Management. PHYSICIAN ASSISTANT CLINICS 2022. [DOI: 10.1016/j.cpha.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Pavone G, Fersini A, Pacilli M, De Fazio M, Panzera P, Ambrosi A, Tartaglia N. Can indocyanine green during laparoscopic sleeve gastrectomy be considered a new intraoperative modality for leak testing? BMC Surg 2022; 22:341. [PMID: 36114496 PMCID: PMC9482312 DOI: 10.1186/s12893-022-01796-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 09/14/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Indocyanine green (ICG) when injected intravenously into the bloodstream allows us to show stomach vascularity in real time. The aim of our study was to observe the preliminary results of the application of indocyanine green fluorescence (IGF) during laparoscopic sleeve gastrectomy (LSG) in our center and how the perfusion of the staple line of the stomach affects the onset of fistula. MATERIALS AND METHODS 82 patients underwent LSG with ICG fluorescence angiography at our center from January 2020 to December 2021. 5 ml of ICG was injected intravenously to identify the blood supply of the stomach, carefully assessing the angle of His. RESULTS In the ICG-tested LSG, we recorded adequate perfusion in all patients but one: the leakage rate was 1.2%. This data is inferior to the non-tested patients' group. CONCLUSION Intraoperative ICG testing may be helpful in determining which patients are at an increased risk for leakage but there are multiple factors contribute to the pathophysiology and the incidence of gastric fistula not only the perfusion. Trial registration Retrospectively registrated.
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Affiliation(s)
- Giovanna Pavone
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Alberto Fersini
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Mario Pacilli
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Michele De Fazio
- Department of General Surgery and Liver Transplantation, University of Bari, 70124 Bari, Italy
| | - Piercarmine Panzera
- Department of General Surgery and Liver Transplantation, University of Bari, 70124 Bari, Italy
| | - Antonio Ambrosi
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Nicola Tartaglia
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
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Fang H, Yao T, Chen Y, Lu Y, Xiong K, Su Y, Zhang Y, Wang Y, Zhang L. An innovative endoscopic management strategy for postoperative fistula after laparoscopic sleeve gastrectomy. Surg Endosc 2022; 36:6439-6445. [PMID: 35102432 DOI: 10.1007/s00464-021-08992-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: 08/26/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Postoperative fistula is a life-threatening complication that lacks a standard treatment strategy after laparoscopic sleeve gastrectomy (LSG). This observational study is the first to report the efficacy and safety of endoscopic full-thickness resection (EFTR) combined with purse-string sutures in treating this complication. PATIENTS AND METHODS The old fistula was resected by EFTR, cut radially, and then sutured with a purse-string. The primary endpoint was complete fistula closure within two months. Endoscopic procedure-related complications were also recorded. RESULTS Eight of 788 LSG patients developed fistulas with an incidence of 1.01%, primarily under the gastroesophageal junction, and the average distance from the center of the fistula to the cardia was 30 ± 6.3 mm. Two patients were cured by conservative treatment, and six received endoscopic sutures. The time from LSG to fistula diagnosis was 12.3 ± 14.4 days. The time from fistula diagnosis to endoscopic repair was 43.8 ± 55.8 days and 21.4 ± 10.0 days after eliminating the data of first case. The average fistula size was 12 ± 10 mm, the average endoscopic procedure duration was 40 ± 16 min, and the average number of endoscopic procedures required was 1.6 ± 0.8. Five patients achieved the primary endpoint, and one patient refused a third endoscopic suture after two sutures. The endoscopy success rate was 83.3%. No endoscopic procedure-related complications occurred. CONCLUSIONS EFTR combined with purse-string sutures is an innovative, safe, and effective endoscopic strategy for postoperative fistula after LSG, avoiding reoperation and allowing early oral feeding.
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Affiliation(s)
- Haiming Fang
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Tingting Yao
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yating Chen
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yan Lu
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Kangwei Xiong
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yuan Su
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yujue Zhang
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yong Wang
- Department of General and Bariatric Surgery, the Second Hospital of Anhui Medical University, Hefei, Anhui, China.
| | - Lijiu Zhang
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, Hefei, Anhui, China.
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, Hefei, Anhui, China.
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Aboueisha MA, Freeman M, Allotey JK, Evans L, Caposole MZ, Tatum D, Levy S, Baker JW, Galvani C. Battle of the buttress: 5-year propensity-matched analysis of staple-line reinforcement techniques from the MBSAQIP database. Surg Endosc 2022; 37:3090-3102. [PMID: 35927350 DOI: 10.1007/s00464-022-09452-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 07/05/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vertical sleeve gastrectomy (VSG) has demonstrated to be safe; however, controversy remains on how to decrease major complications, particularly bleeding and leaks. There are variations in staple-line reinforcement techniques, including no reinforcement, oversewing, and buttressing. We sought to evaluate the effect of those methods on post-operative complications using the Metabolic and Bariatric Surgery Accreditation Quality Initiative Program (MBSAQIP) database. METHODS The MBSAQIP was queried for patients who underwent VSG during 2015-2019. A propensity-matched analysis was performed between different staple-line reinforcement (SLR) methods, specifically No reinforcement (NR), Oversewing (OS), and Buttressing (BR). The primary outcome of interest was complications within 30 days. RESULTS A total of 513,354 VSG cases were analyzed. The cohort was majority female (79.0%), with mean (SD) age of 44.2 ± 11.9 years and mean BMI of 45 ± 7.8 kg/m2. Frequency of SLR methods used was 54%BR, 25.6%NR, 10.8% BR + OS, and 9.8%OS. There were no differences in rate of leaks among SLR methods. Compared to NR, BR was associated with decreased rate of reoperations, overall bleeding, and major bleeding (p < 0.05) but prolonged operative time and length of stay (LOS) (p < 0.05). OS was associated with decreased overall bleeding (p < 0.05) but prolonged operative times and length of stay (p < 0.05) compared to NR. Compared to BR, OS was associated with increased operative times, LOS, and rates of post-operative ventilator use, pneumonia, and venous thrombosis (p < 0.05). Patients with bleeding were associated with lower rate of BR (56% vs 61%) and higher rate of NR (34% vs 28%) compared to patients with no bleeding. Bleeding was associated with a greater frequency of leaks (4.4% vs 0.3%), along with higher morbidity and mortality (p < 0.05). CONCLUSIONS Of the reinforcement methods evaluated, BR and OS were both associated with decreased bleeding despite longer operative times. No method was found to significantly reduce incidence of leaks; however, bleeding was associated with increased incidence of leaks, morbidity, and mortality. The liberal use of SLR techniques is recommended for further optimization of patient outcomes after VSG.
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Affiliation(s)
- Mohamed A Aboueisha
- Division of Minimally Invasive Surgery and Bariatric, Department of Surgery, Tulane University, 1430 Tulane Ave., Mailbox #8622, New Orleans, LA, 70112, USA
| | - Meredith Freeman
- Division of Minimally Invasive Surgery and Bariatric, Department of Surgery, Tulane University, 1430 Tulane Ave., Mailbox #8622, New Orleans, LA, 70112, USA
| | - Jonathan K Allotey
- Division of Minimally Invasive Surgery and Bariatric, Department of Surgery, Tulane University, 1430 Tulane Ave., Mailbox #8622, New Orleans, LA, 70112, USA
| | - Leah Evans
- Division of Minimally Invasive Surgery and Bariatric, Department of Surgery, Tulane University, 1430 Tulane Ave., Mailbox #8622, New Orleans, LA, 70112, USA
| | - Michael Z Caposole
- Division of Minimally Invasive Surgery and Bariatric, Department of Surgery, Tulane University, 1430 Tulane Ave., Mailbox #8622, New Orleans, LA, 70112, USA
| | - Danielle Tatum
- Department of Surgery, Tulane University, New Orleans, LA, 70112, USA
| | - Shauna Levy
- Division of Minimally Invasive Surgery and Bariatric, Department of Surgery, Tulane University, 1430 Tulane Ave., Mailbox #8622, New Orleans, LA, 70112, USA
| | - John W Baker
- Division of Minimally Invasive Surgery and Bariatric, Department of Surgery, Tulane University, 1430 Tulane Ave., Mailbox #8622, New Orleans, LA, 70112, USA
| | - Carlos Galvani
- Division of Minimally Invasive Surgery and Bariatric, Department of Surgery, Tulane University, 1430 Tulane Ave., Mailbox #8622, New Orleans, LA, 70112, USA.
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27
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Intriago JMV, de Moura DTH, do Monte Junior ES, Proença IM, Ribeiro IB, Sánchez-Luna SA, Bernardo WM, de Moura EGH. Endoscopic Vacuum Therapy (EVT) for the Treatment of Post-Bariatric Surgery Leaks and Fistulas: a Systematic Review and Meta-analysis. Obes Surg 2022; 32:3435-3451. [PMID: 35918596 DOI: 10.1007/s11695-022-06228-0] [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: 04/28/2022] [Revised: 07/21/2022] [Accepted: 07/24/2022] [Indexed: 11/26/2022]
Abstract
Bariatric surgery remains the most effective treatment for morbid obesity and its comorbidities. However, post-surgical leaks and fistulas can occur in about 1-5% of patients, with challenging treatment approaches. Endoscopic vacuum therapy (EVT) has emerged as a promising tool due to its satisfactory results and accessibility. In this first systematic review and meta-analysis on the subject, EVT revealed rates of 87.2% clinical success, 6% moderate adverse events, and 12.5% system dislodgements, requiring 6.47 EVT system exchanges every 4.39 days, with a dwell time of 25.67 days and a total length of hospitalization of 44.43 days. Although our results show that EVT is a safe and effective therapy for post-surgical leaks and fistulas, they should be interpreted with caution due to the paucity of available data.
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Affiliation(s)
- Josselyn Mariana Vera Intriago
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
| | - Diogo Turiani Hourneaux de Moura
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
| | - Epifanio Silvino do Monte Junior
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
| | - Igor Mendonça Proença
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
| | - Igor Braga Ribeiro
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil.
| | - Sergio A Sánchez-Luna
- Basil I. Hirschowitz Endoscopic Center of Excellence, Division of Gastroenterology & Hepatology, Department of Internal Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Wanderley Marques Bernardo
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
| | - Eduardo Guimarães Hourneaux de Moura
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
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28
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Lu CY, Liu YL, Liu KJ, Xu S, Yao HL, Li L, Guo ZS. Differences in examination results of small anastomotic fistula after radical gastrectomy with afterward treatments: A case report. World J Clin Cases 2022; 10:7609-7616. [PMID: 36157983 PMCID: PMC9353917 DOI: 10.12998/wjcc.v10.i21.7609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/18/2022] [Accepted: 06/15/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastrografin swallow, methylthioninium chloride test, and computed tomography (CT) are the main methods for postoperative anastomotic fistula detection. Correct selection and application of examinations and therapies are significant for the early diagnosis and treatment of small anastomotic fistulas after radical gastrectomy, which are conducive to postoperative recovery.
CASE SUMMARY A 44-year-old woman underwent radical total gastrectomy for laparoscopic gastric cancer. The patient developed a fever after surgery. The methylthioninium chloride test and early CT suggested no anastomotic fistula, but gastrografin swallow and late CT showed the opposite result. The fistula was successfully closed using an endoscopic clip. The methylthioninium chloride test, gastrografin, and CT performed on different postoperative dates for small esophagojejunostomy fistulas are different. The size of the anastomotic fistula is an important factor for the success of endoscopic treatment.
CONCLUSION The advantages and limitations of the diagnosis of different examinations of small esophagojejunostomy fistulas are noteworthy. The size of the leakage of the anastomosis is an important basis for selecting the repair method.
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Affiliation(s)
- Chen-Yang Lu
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Central South University, Changsha 410011, Hunan Province, China
| | - Ya-Li Liu
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha 410011, Hunan Province, China
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Central South University, Changsha 410011, Hunan Province, China
| | - Kui-Jie Liu
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha 410011, Hunan Province, China
| | - Shu Xu
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha 410011, Hunan Province, China
| | - Hong-Liang Yao
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha 410011, Hunan Province, China
| | - Lun Li
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha 410011, Hunan Province, China
| | - Zhu-Shu Guo
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha 410011, Hunan Province, China
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Central South University, Changsha 410011, Hunan Province, China
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29
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Suter K, Bui HT, Chan STF. Management of Severe Sleeve Gastrectomy Leaks by a Roux-en-Y Gastrojejunostomy and Suction Isoperistaltic Jejuno-gastroesophagostomy Tube (SIJGET): a Novel Approach. Obes Surg 2022; 32:2816-2819. [PMID: 35687254 DOI: 10.1007/s11695-022-06147-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Katherine Suter
- Department of Surgery, Upper Gastrointestinal Surgery Unit, Western Health, 160 Gordon St, Melbourne, VIC, 3011, Australia.
| | - Hai T Bui
- Department of Surgery, Upper Gastrointestinal Surgery Unit, Western Health, 160 Gordon St, Melbourne, VIC, 3011, Australia.,Melbourne Medical School, Western Campus, The University of Melbourne, Melbourne, Australia
| | - Steven T F Chan
- Department of Surgery, Upper Gastrointestinal Surgery Unit, Western Health, 160 Gordon St, Melbourne, VIC, 3011, Australia.,Melbourne Medical School, Western Campus, The University of Melbourne, Melbourne, Australia
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30
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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.
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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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31
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Park JY. Diagnosis and Management of Postoperative Complications After Sleeve Gastrectomy. JOURNAL OF METABOLIC AND BARIATRIC SURGERY 2022; 11:1-12. [PMID: 36685085 PMCID: PMC9848960 DOI: 10.17476/jmbs.2022.11.1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 01/24/2023]
Abstract
Sleeve gastrectomy (SG) has demonstrated excellent outcomes in terms of weight loss and resolution of obesity-related comorbidities as a single procedure. It has gained rapidly increasing popularity among bariatric surgeons and patients over the last two decades. This is due to its relative ease of use and less frequent morbidities related to the procedure. Even though the overall complication rate after SG is reported to be lower than conventional Roux-en-Y gastric bypass or biliopancreatic diversion, it still affects 1-10% of the patients undergoing SG, which is not negligible. Early postoperative complications that can occur within 30 days after SG include hemorrhage, leakage, sleeve stenosis, and reflux. Thromboembolic events are rare but can occur after surgery. Here, we review the incidence, diagnosis, and management of these early postoperative complications.
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Affiliation(s)
- Ji Yeon Park
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.,Department of Surgery, Kyungpook National University Chilgok Hospital, Daegu, Korea
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32
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Kiriakopoulos A, Kounatidis N, Menenakos I, Kostrova M, Zografos K, Menenakos E. Non-stenting treatment versus endoscopic stent placement in staple line leaks after laparoscopic sleeve gastrectomy. Langenbecks Arch Surg 2022; 407:1863-1872. [PMID: 35333965 DOI: 10.1007/s00423-022-02498-5] [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: 01/14/2021] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Presentation of results of non-stenting treatment versus endoscopic stenting placement in gastric staple leaks after laparoscopic sleeve gastrectomy (LSG). METHODS Between January 2007 and August 2020, 1371 eligible patients underwent LSG. After gastric leak detection, patients were classified into treatment groups A (endoscopic stent placement) and B (non-stenting management). Overall hospital stay, the time to complete gastric leak resolution and the incidence of further operative management constituted the main outcome measures. Statistical analysis included descriptive statistics and linear regression tests as needed. RESULTS A total of 27 patients (19 F/8 M, median age: 44.8 years (range: 36-58) with median preoperative BMI: 43.5 kg/m2 (range: 37.0-48.7)) presented with gastric staple line leak (1.9%) - mean detection day 5.8 postop (range: 1-12). Eight patients enrolled in group A and 19 patients in group B. The mean hospital stay for group A was 41.2 days (range: 24-60) versus 15 days (range: 12-18) for group B (p < 0.001). Complete leakage resolution was observed at mean 42.4 days (range 25-60) for group A and 34.5 days (range: 28-40) for group B patients, (p = 0.025). Only 2 group A patients accomplished complete leak resolution without additional intervention. Five group A patients (62.5%) versus 4 group B patients (21.1%) needed operative intervention during the treatment course (p = 0.037). CONCLUSIONS Conservative, non-stenting treatment of staple line leaks after LSG is feasible and is associated with superior results in terms of hospital say and leak resolution in comparison to endoscopic stenting.
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Affiliation(s)
- Andreas Kiriakopoulos
- 5th Surgical Clinic, "Evgenideion Hospital", National and Kapodistrian University of Athens School of Medicine, Papadiamantopoulou 20 Str., PO: 11528, Athens, Greece.
| | - Nefeli Kounatidis
- 5th Surgical Clinic, "Evgenideion Hospital", National and Kapodistrian University of Athens School of Medicine, Papadiamantopoulou 20 Str., PO: 11528, Athens, Greece
| | - Ilias Menenakos
- Actuarial Science, Department of Statistics, London School of Economics, London, UK
| | - Maria Kostrova
- Actuarial Science, Department of Statistics, London School of Economics, London, UK
| | - Konstantinos Zografos
- 5th Surgical Clinic, "Evgenideion Hospital", National and Kapodistrian University of Athens School of Medicine, Papadiamantopoulou 20 Str., PO: 11528, Athens, Greece
| | - Evangelos Menenakos
- 5th Surgical Clinic, "Evgenideion Hospital", National and Kapodistrian University of Athens School of Medicine, Papadiamantopoulou 20 Str., PO: 11528, Athens, Greece.,1st Clinic, Division of Morbid Obesity and Metabolic Surgery, "Ippokrateion Hospital", National and Kapodistrian University of Athens School of Medicine, Athens, Greece
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33
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Ekman M, Girnyi S, Marano L, Roviello F, Chand M, Diana M, Polom K. Near-Infrared Fluorescence Image-Guided Surgery in Esophageal and Gastric Cancer Operations. Surg Innov 2022; 29:540-549. [DOI: 10.1177/15533506211073417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Near-infrared fluorescence image-guided surgery helps surgeons to see beyond the classical eye vision. Over the last few years, we have witnessed a revolution which has begun in the field of image-guided surgery. Purpose, and Research design Fluorescence technology using indocyanine green (ICG) has shown promising results in many organs, and in this review article, we wanted to discuss the 6 main domains where fluorescence image-guided surgery is currently used for esophageal and gastric cancer surgery. Study sample and data collection Visualization of lymphatic vessels, tumor localization, fluorescence angiography for anastomotic evaluation, thoracic duct visualization, tracheal blood flow analysis, and sentinel node biopsy are discussed. Conclusions It seems that this technology has already found its place in surgery. However, new possibilities and research avenues in this area will probably make it even more important in the near future.
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Affiliation(s)
- Marcin Ekman
- Department of Surgical Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Sergii Girnyi
- Department of Surgical Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Luigi Marano
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Franco Roviello
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Manish Chand
- Wellcome EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London
| | - Michele Diana
- Department of Surgical Oncology, Medical University of Gdansk, Gdansk, Poland
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
- Wellcome EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London
| | - Karol Polom
- Department of Surgical Oncology, Medical University of Gdansk, Gdansk, Poland
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Negm S, Amin M, Shafiq A, Atef B, Yassin M, Farag A. The short-term outcome of distal mesogastric fixation after laparoscopic sleeve gastrectomy: a randomized controlled trial. Surg Today 2022; 52:510-513. [PMID: 35099602 DOI: 10.1007/s00595-022-02459-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: 04/20/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The proposed etiology of leakage after laparoscopic sleeve gastrectomy may be the axial rotation of the stomach owing to the loss of abdominal ligament fixation along the greater curvature of the stomach. The mechanism of increased intra-gastric pressure due to axial gastric rotation may place a great deal of stress on the staple lines, leading to an increased incidence of leakage. Other complications may occur, including vomiting, food intolerance or persistent reflux. METHODS This study was registered in ClinicalTrials.gov (ID: NCT04834323). This study included patients who were admitted to our center to undergo laparoscopic sleeve gastrectomy. Cases were collected in the period from December 2019 to December 2020. The study population included 83 patients, who were divided into the following two groups: Group 1 included 42 patients who received distal mesogastric fixation after laparoscopic sleeve gastrectomy; Group 2 included 41 patients who received laparoscopic sleeve gastrectomy alone without distal mesogastric fixation. RESULTS No leakage or axial rotation occurs after laparoscopic sleeve gastrectomy with distal fixation, while in patients without distal fixation, leakage and axial rotation occurred with no statistically significant differences between the two groups. Leakage and axial rotation occurred two times more frequently among patients who received laparoscopic sleeve gastrectomy without distal fixations. CONCLUSION Distal mesogastric fixation after laparoscopic sleeve gastrectomy decreased the axial gastric rotation and subsequently decreased gastric leakage.
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Affiliation(s)
- Said Negm
- Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Mohamed Amin
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Shafiq
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Baher Atef
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Ahmed Farag
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Głuszyńska P, Diemieszczyk I, Szczerbiński Ł, Krętowski A, Major P, Razak Hady H. Risk Factors for Early and Late Complications after Laparoscopic Sleeve Gastrectomy in One-Year Observation. J Clin Med 2022; 11:jcm11020436. [PMID: 35054132 PMCID: PMC8779692 DOI: 10.3390/jcm11020436] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 12/10/2022] Open
Abstract
BACKGROUND Although laparoscopic sleeve gastrectomy (LSG) is considered a safe bariatric procedure in the treatment of obesity, it still involves a risk of developing postoperative complications. Knowledge of risk factors for possible complications would allow appropriate preoperative planning, optimization of postoperative care, as well as early diagnosis and treatment. The aim of this study was to evaluate risk factors for complications after laparoscopic sleeve gastrectomy. METHODS A retrospective study of 610 patients who underwent LSG at a tertiary institution were included in the study through retrospective analysis of the medical data. Complications were categorized as early (<30 days) and late (≥30 days) and evaluated according to the Clavien-Dindo Classification. RESULTS Early complications were observed in 35 patients (5.74%) and late complications occurred in 10 patients (1.64%). Independent risk factors of early complications after laparoscopic sleeve gastrectomy included hypercholesterolemia (OR 3.73; p-value = 0.023) and smoking (OR = 274.66, p-value < 0.001). Other factors that may influence the postoperative course are length of hospital stay and operation time. Smoking, peptic ulcer diseases and co-existence of hiatal hernia were found to be an independent predictors of late complications. CONCLUSIONS Smoking is associated with the higher risk of both, early and late complications, while hypercholesterolemia with only <30 days complications after laparoscopic sleeve gastrectomy.
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Affiliation(s)
- Paulina Głuszyńska
- 1st Department of General and Endocrine Surgery, Medical University of Bialystok, 15-089 Bialystok, Poland; (I.D.); (H.R.H.)
- Correspondence: ; Tel.: +48-85-831-8279
| | - Inna Diemieszczyk
- 1st Department of General and Endocrine Surgery, Medical University of Bialystok, 15-089 Bialystok, Poland; (I.D.); (H.R.H.)
| | - Łukasz Szczerbiński
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, 15-089 Bialystok, Poland; (Ł.S.); (A.K.)
| | - Adam Krętowski
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, 15-089 Bialystok, Poland; (Ł.S.); (A.K.)
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, 31-008 Krakow, Poland;
| | - Hady Razak Hady
- 1st Department of General and Endocrine Surgery, Medical University of Bialystok, 15-089 Bialystok, Poland; (I.D.); (H.R.H.)
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Ferraz ÁAB, Santa-Cruz F, Belfort JV, Sá VCT, Siqueira LT, Araújo-Júnior JGC. THE ROUTINE USE OF THE METHYLENE BLUE TEST IN SLEEVE GASTRECTOMY: WHY NOT? ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2022; 34:e1612. [PMID: 35019124 PMCID: PMC8735257 DOI: 10.1590/0102-672020210002e1612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/29/2021] [Indexed: 11/22/2022]
Abstract
Background:
Although considered a safe procedure, sleeve gastrectomy (SG) has a non-negligible risk of major postoperative complications related to it, with special attention to gastric leaks.
Aim:
Evaluate the clinical value of the methylene blue test (MBT) in predicting the occurrence of post-SG leaks.
Methods: Retrospective study that included 1136 patients who underwent SG with intraoperative MBT between 2012 and 2016. Sensitivity, specificity, positive predictive value (PPV) and negative predicted value (NPV) were calculated to determine the clinical correlation between the MBT and the occurrence of postoperative leaks. Staple line oversewing was performed in all patients who presented positive MBT.
Results:
Laparoscopic SG was performed in 97.0% of cases; open in 2.3%, and robotic in 0.7%. MBT was positive in 19 cases (1.67%). One positive MBT occurred during an open SG and the other 18 at laparoscopy. Moreover, there were nine cases (0.8%) of postoperative leaks, among which, only two presented positive MBT. MBT diagnostic value was evaluated through the calculation of sensitivity (22.0%), specificity (98.0%), PPV (11.0%) and NPV (99.0%). There were no cases of allergic reaction or any other side effect with the use of the methylene blue solution.
Conclusion:
MBT showed high specificity and negative predictive value, thus presenting an important value to rule out the occurrence of postoperative leaks.
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Affiliation(s)
- Álvaro A B Ferraz
- Department of Surgery, Hospital de Clínicas, Federal University of Pernambuco, Recife, PE, Brazil.,Gastrointestinal Surgery Service, Esperança Hospital, Rede D'Or São Luiz, Recife, PE, Brazil
| | | | | | - Vladimir C T Sá
- General Surgery Service, Hospital Agamenon Magalhães, Recife, PE, Brazil
| | - Luciana T Siqueira
- Department of Surgery, Hospital de Clínicas, Federal University of Pernambuco, Recife, PE, Brazil
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MEOLI F, CORALLINO D, PALMIERI L, CORDOVA HERENCIA IE, PAGANINI AM. Total gastrectomy after endotherapy failure for management of chronic gastric leakage from sleeve gastrectomy: the end of a nightmare. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.20.05193-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Billmann F, Pfeiffer A, Sauer P, Billeter A, Rupp C, Koschny R, Nickel F, von Frankenberg M, Müller-Stich BP, Schaible A. Endoscopic Stent Placement Can Successfully Treat Gastric Leak Following Laparoscopic Sleeve Gastrectomy If and Only If an Esophagoduodenal Megastent Is Used. Obes Surg 2022; 32:64-73. [PMID: 34731416 PMCID: PMC8752538 DOI: 10.1007/s11695-021-05467-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/05/2021] [Accepted: 05/05/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Gastric staple line leakage (GL) is a serious complication of laparoscopic sleeve gastrectomy (LSG), with a specific mortality ranging from 0.2 to 3.7%. The current treatment of choice is stent insertion. However, it is unclear whether the type of stent which is inserted affects treatment outcome. Therefore, we aimed not only to determine the effectiveness of stent treatment for GL but also to specifically clarify whether treatment outcome was dependent on the type of stent (small- (SS) or megastent (MS)) which was used. PATIENTS AND METHODS A single-centre retrospective study of 23 consecutive patients was conducted to compare the outcomes of SS (n = 12) and MS (n = 11) for the treatment of GL following LSG. The primary outcome measure was the success rate of stenting, defined as complete healing of the GL without changing the treatment strategy. Treatment change or death were both coded as failure. RESULTS The success rate of MS was 91% (10/11) compared to only 50% (6/12) for SS (p = 0.006). An average of 2.3 ± 0.5 and 6.8 ± 3.7 endoscopies were required to achieve healing in the MS and SS groups respectively (p < 0.001). The average time to resumption of oral nutrition was shorter in the MS group (1.4 ± 1.1 days vs. 23.1 ± 33.1 days, p = 0.003). CONCLUSIONS Stent therapy is only effective and safe for the treatment of GL after LSG if a MS is used. Treatment with a MS may not only increase treatment success rates but may also facilitate earlier resumption of oral nutrition and shorten the duration of hospitalization.
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Affiliation(s)
- Franck Billmann
- Department of Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 420, D-69120, Heidelberg, Germany
| | - Aylin Pfeiffer
- Department of Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 420, D-69120, Heidelberg, Germany
| | - Peter Sauer
- Interdisciplinary Endoscopic Center, University Hospital of Heidelberg, Im Neuenheimer Feld 420, D-69120, Heidelberg, Germany
| | - Adrian Billeter
- Department of Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 420, D-69120, Heidelberg, Germany
| | - Christian Rupp
- Interdisciplinary Endoscopic Center, University Hospital of Heidelberg, Im Neuenheimer Feld 420, D-69120, Heidelberg, Germany
| | - Ronald Koschny
- Interdisciplinary Endoscopic Center, University Hospital of Heidelberg, Im Neuenheimer Feld 420, D-69120, Heidelberg, Germany
| | - Felix Nickel
- Department of Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 420, D-69120, Heidelberg, Germany
| | | | - Beat Peter Müller-Stich
- Department of Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 420, D-69120, Heidelberg, Germany.
| | - Anja Schaible
- Department of Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 420, D-69120, Heidelberg, Germany
- Interdisciplinary Endoscopic Center, University Hospital of Heidelberg, Im Neuenheimer Feld 420, D-69120, Heidelberg, Germany
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Şen O, Türkçapar AG. Review of Our Experience Using Modified Staple Line Suturing Technique in Laparoscopic Sleeve Gastrectomy. Surg Laparosc Endosc Percutan Tech 2021; 32:213-216. [PMID: 34966154 DOI: 10.1097/sle.0000000000001024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/21/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has become the most common bariatric surgical method in recent years. Although LSG provides good outcomes, serious complications such as leakage, bleeding, and stenosis may develop postoperatively. Numerous staple line reinforcement methods have been used to reduce complications. Whether each one of these practices is effective remains controversial. AIM Our study aims to assess outcomes and safety of modified (purse-string+oversewing) staple line suturing technique for patients who underwent LSG. MATERIALS AND METHODS A total of 505 patients who underwent LSG with modified staple line suturing technique between March 2018 and February 2021 were included in this retrospective study. Age, sex, body mass index, operation time, perioperative and postoperative 30-day complications were recorded in all patients. RESULTS Of 505 patients (59.6% female) with a mean age of 37.6 years (minimum to maximum: 12 to 68 y) and median body mass index of 40.2 kg/m2 (minimum to maximum: 32 to 75 kg/m2) underwent LSG. LSG was performed as revision surgery in 17 (3.4%) patients. Five (1%) patients also underwent concomitant cholecystectomy. The mean operation time was 92 minutes (75 to 110 min) in our primary LSG cases. Operative complications included minor hepatic injury in 8 (1.6%) and anesthesia awareness in 3 (0.6%) patients. Postoperative complications included bleeding which occurred in 2 (0.4%) patients, portomesenteric vein thrombosis in 1 (0.2%), and minor wound infection in 3 (0.6%) patients. There was no leak, no stenosis, and no mortality. CONCLUSION Sleeve gastrectomy with modified staple line suturing technique is an effective method and could be safely applied with low morbidity.
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Affiliation(s)
- Ozan Şen
- Department of Health Sciences, Medical Faculty, Nişantaşi University
- Obesity Center, Türkçapar Bariatrics, Istanbul, Turkey
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Albarrak AA. Partial dehiscence of an intraoperative staple line during laparoscopic sleeve gastrectomy: A case report. Int J Surg Case Rep 2021; 91:106642. [PMID: 34896055 PMCID: PMC8858736 DOI: 10.1016/j.ijscr.2021.106642] [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: 10/04/2021] [Revised: 11/21/2021] [Accepted: 11/28/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Leakage along a staple line during sleeve gastrectomy is a serious complication. Mechanical causes are uncommon; however, they should be considered as sources of acute postoperative leaks. The presented case discusses an important intraoperative complication with an avoidable cause that could benefit practicing surgeons as well as residents in training programs. Presentation of case This case describes the mechanical failure of a stapler that was identified intraoperatively. The staple line was oversewn using a 3–0 V Lok suture. The methylene blue test was negative, and the patient had an uneventful postoperative recovery. Discussion While most leaks were attributed to ischemia of the upper third of the stomach, leaks occurring within the first three postoperative days have a different pathophysiology. This may involve mechanical complications (stapler failure), direct gastric tissue trauma from aggressive handling, or thermal injuries. In our case, the likely cause of the partial dehiscence was the proximity of the stapler to the bougie and an unnoticed small fold at the antrum. Conclusion Surgeons should avoid placing the stapler too close to the bougie. Furthermore, surgeons should ensure that the stomach is flat and there are no gastric folds that could lead to stapling failure. Staple line dehiscence in sleeve gastrectomy is a serious complication. We recommend separating the stapler and bougie and avoiding gastric wall folds. Oversewing the staple line was sufficient to address dehiscence in this case.
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Affiliation(s)
- Abdullah A Albarrak
- Department of Surgery, College of Medicine, Majmaah University, Industrial area, Al Majma'ah 15341, Saudi Arabia.
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Yu Q, Saeed K, Okida LF, Gutierrez Blanco DA, Lo Menzo E, Szomstein S, Rosenthal R. Outcomes of laparoscopic sleeve gastrectomy with and without antrectomy in severely obese subjects. Evidence from randomized controlled trials. Surg Obes Relat Dis 2021; 18:404-412. [PMID: 34933811 DOI: 10.1016/j.soard.2021.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/02/2021] [Accepted: 11/12/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (SG) has been proven safe and effective in achieving weight loss. However, the distance from the pylorus where resection should begin has been debated. OBJECTIVES To compare the clinical outcomes of laparoscopic SG with antrum resection (AR) versus preservation (AP) for bariatric purposes by conducting a meta-analysis of randomized controlled trials (RCT). SETTING Academic hospital, United States. METHODS PubMed and Cochrane Library were queried for RCTs from establishment to August 2020. The following key search terms were used: "sleeve gastrectomy" AND ("antrectomy" OR "antrum") AND ("randomized" OR "random"). The following data were extracted: author, publication year, country, sample size, follow-up duration, and clinical outcomes, including weight-related: excess weight loss (EWL), total weight loss (TWL), body mass index (BMI), operation time, length of hospital stay, complication rates, and resolution of obesity-related comorbidities. RESULTS A total of 9 unique RCTs including 492 AR and 385 AP patients were screened and included in the final quantitative analysis. Patients who underwent SG with AR showed higher EWL and TWL at 6 months (EWL: P < .001; TWL: P = .006), and 1 year (EWL: P = .013; P < .001) postoperatively. The BMI was also lower in the AR group 3 months (P = .013) and 6 months (P = .003) postoperatively. However, the EWL and BMI at 2 years were comparable between both groups (P = .222 and P = .908, respectively). No statistical significance was observed in terms of operating time, staple line disruption, bleeding, complications with a Clavien-Dindo Grade >III, resolution of comorbidities (hypertension, diabetes, hyperlipidemia, arthritis/back pain), and de novo gastroesophageal reflux disease (P > .05). AP was associated with a slightly shorter postoperative hospital stay (4.0 versus 3.1 days, P = .039). CONCLUSION Laparoscopic SG with AR is associated with superior weight loss in the short-term compared with AP. However, mid-term follow-up beyond 1 year showed no significant differences in BMI or incidence of de novo gastroesophageal reflux disease.
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Affiliation(s)
- Qian Yu
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Kashif Saeed
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Luis Felipe Okida
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida
| | | | - Emanuele Lo Menzo
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Samuel Szomstein
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Raul Rosenthal
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida.
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Boeker C, Schneider B, Markov V, Mall J, Reetz C, Wilkens L, Hakami I, Stroh C, Köhler H. Primary Sleeve Gastrectomy and Leaks: The Impact of Fundus-Wall Thickness and Staple Heights on Leakage-An Observational Study of 500 Patients. Front Surg 2021; 8:747171. [PMID: 34746223 PMCID: PMC8566748 DOI: 10.3389/fsurg.2021.747171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/24/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: The most feared complication of laparoscopic sleeve gastrectomy (LSG) is staple-line leakage. Staple height and fundus-wall thickness might influence such leakage, and this study examined their possible impact on leak incidence. Factors including gender, age, comorbidities, and reinforcement of the staple line were also investigated. Methods: A total of 500 patients between 17 and 71 years of age who were scheduled for LSG were selected to participate in the study. For technical reasons, 53 were excluded. The fundus-wall thickness of 447 patients after LSG was investigated. The impact of staple height, fundus-wall thickness, demographic and medical factors on leak incidence were investigated. Most of our patients (309) were female (69%), while 138 were male (31%). Results: The mean thickness of the proximal fundus wall was 2,904 μm, 3,172 μm in men and 2,784 μm in women. The leak rate was 4.9%. Age, fundus-wall thickness, and BMI showed a strong influence on leak risk, but this effect was significant only for age (p = 0.01). Patient gender and staple size showed no significant influence on the correlation between fundus-wall thickness and leak risk. Gender displayed a small effect of influence on this correlation, with η2 = 0.05. Discussion: Because older age had a significant effect on increasing the risk of staple-line leakage, there is a need for a more specific focus on these patients. Thinner fundus wall and female gender might predispose patients to staple-line leaks, but a significant value could not be reached. Therefore, staple size should remain the surgeon's choice based on clinical experience.
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Affiliation(s)
- Clara Boeker
- Department of General, Visceral, Vascular and Bariatric Surgery, Klinikum Nordstadt, Hannover, Germany
| | | | - Valentin Markov
- Department of Psychology, University of Hildesheim, Hildesheim, Germany
| | - Julian Mall
- Department of General, Visceral, Vascular and Bariatric Surgery, Klinikum Nordstadt, Hannover, Germany
| | - Christian Reetz
- Department of General, Visceral, Vascular and Bariatric Surgery, Klinikum Nordstadt, Hannover, Germany
| | - Ludwig Wilkens
- Department of Pathology, Klinikum Nordstadt, Hannover, Germany
| | - Ibrahim Hakami
- Department of General, Visceral and Bariatric Surgery, College of Medicine at Jazan University, Jizan, Saudi Arabia
| | - Christine Stroh
- Department of Bariatric Surgery, Stiftung Rehabilitation Heidelberg Waldklinikum, Gera, Germany
| | - Hinrich Köhler
- Department of General, Visceral and Bariatric Surgery, Herzogin Elisabeth Hospital, Braunschweig, Germany
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Feitosa PHF, Santa-Cruz F, Padilha MV, Siqueira LT, Kreimer F, Ferraz ÁA. Endoscopic Self-Expandable Stent for the Treatment of Gastric Fistula After Sleeve Gastrectomy: A Descriptive Review. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2021.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | - Luciana T. Siqueira
- Real Hospital Português de Beneficência, Recife, Brazil
- Department of Surgery, Federal University of Pernambuco, Recife, Brazil
| | - Flávio Kreimer
- Real Hospital Português de Beneficência, Recife, Brazil
- Department of Surgery, Federal University of Pernambuco, Recife, Brazil
| | - Álvaro A.B. Ferraz
- Department of Surgery, Federal University of Pernambuco, Recife, Brazil
- Gastrointestinal Surgery Unit, Hospital Esperança—Rede D'Or São Luiz, Recife, Brazil
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Debs T, Iannelli A, Frey S, Petrucciani N, Korkmaz C, Ben Amor V, Chenaitia H, Vanbiervliet G, Gugenheim J, Ben Amor I. Mesenchymal Stem Cells and Platelet Rich Plasma Therapy to Treat Leak After Sleeve Gastrectomy. J Surg Res 2021; 268:405-410. [PMID: 34416412 DOI: 10.1016/j.jss.2021.06.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/25/2021] [Accepted: 06/29/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND One of the most feared and life-threatening complications after sleeve gastrectomy (SG) is staple line leak, with an incidence between 1 and 4%. Stable patients may be managed conservatively, with antibiotics, percutaneous drainage and endoscopy-based treatment. We propose mesenchymal stem cells (MSC) and platelet rich plasma (PRP) therapy as an innovative technique to treat leak after SG. MATERIAL AND METHODS Bone marrow MSCs is obtained by centrifugation of tibial puncture specimen. A peripheral whole blood sample is retrieved from the patient and centrifuged to obtain PRP. During endoscopy, the first 10 mL are injected in 4quadrants (equal volume) in the submucosae around the internal orifice. The second 10 mL are injected in the wall of the fistula tract. RESULTS The immediate course following the endoscopy was uneventful in both reported cases. The leaks healed in 30 and 42 D, respectively. Oral nutrition was progressively started during the third WK and fourth WK following the injection for both patients. No adverse event was noted during the follow-up period. CONCLUSION The management of fistulas post SG is controversial and actual available treatments present a relatively prolonged healing time. MSC administration retains a high potential value in the treatment of these fistulas. Further studies and wider clinical trials are mandatory to determine the impact of MSC administration.
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Affiliation(s)
- Tarek Debs
- Digestive Surgery and Liver Transplantation Unit, University Hospital of Nice, Nice, France
| | - Antonio Iannelli
- Digestive Surgery and Liver Transplantation Unit, University Hospital of Nice, Nice, France
| | - Sebastien Frey
- Digestive Surgery and Liver Transplantation Unit, University Hospital of Nice, Nice, France
| | - Niccolo Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
| | - Carine Korkmaz
- Digestive Surgery and Liver Transplantation Unit, University Hospital of Nice, Nice, France
| | | | | | | | - Jean Gugenheim
- Digestive Surgery and Liver Transplantation Unit, University Hospital of Nice, Nice, France
| | - Imed Ben Amor
- Digestive Surgery and Liver Transplantation Unit, University Hospital of Nice, Nice, France
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Gjeorgjievski M, Imam Z, Cappell MS, Jamil LH, Kahaleh M. A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks. J Clin Gastroenterol 2021; 55:551-576. [PMID: 33234879 DOI: 10.1097/mcg.0000000000001451] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bariatric surgery leaks result in significant morbidity and mortality. Experts report variable therapeutic approaches, without uniform guidelines or consensus. OBJECTIVE To review the pathogenesis, risk factors, prevention, and treatment of gastric sleeve leaks, with a focus on endoscopic approaches. In addition, the efficacy and success rates of different treatment modalities are assessed. DESIGN A comprehensive review was conducted using a thorough literature search of 5 online electronic databases (PubMed, PubMed Central, Cochrane, EMBASE, and Web of Science) from the time of their inception through March 2020. Studies evaluating gastric sleeve leaks were included. MeSH terms related to "endoscopic," "leak," "sleeve," "gastrectomy," "anastomotic," and "bariatric" were applied to a highly sensitive search strategy. The main outcomes were epidemiology, pathophysiology, diagnosis, treatment, and outcomes. RESULTS Literature search yielded 2418 studies of which 438 were incorporated into the review. Shock and peritonitis necessitate early surgical intervention for leaks. Endoscopic therapies in acute and early leaks involve modalities with a focus on one of: (i) defect closure, (ii) wall diversion, or (iii) wall exclusion. Surgical revision is required if endoscopic therapies fail to control leaks after 6 months. Chronic leaks require one or more endoscopic, radiologic, or surgical approaches for fluid collection drainage to facilitate adequate healing. Success rates depend on provider and center expertise. CONCLUSION Endoscopic management of leaks post sleeve gastrectomy is a minimally invasive and effective alternative to surgery. Their effect may vary based on clinical presentation, timing or leak morphology, and should be tailored to the appropriate endoscopic modality of treatment.
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Affiliation(s)
- Mihajlo Gjeorgjievski
- Departments of Gastroenterology & Hepatology
- Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical Center, New Brunswick, NJ
| | - Zaid Imam
- Departments of Gastroenterology & Hepatology
- Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Mitchell S Cappell
- Departments of Gastroenterology & Hepatology
- Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Laith H Jamil
- Departments of Gastroenterology & Hepatology
- Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Michel Kahaleh
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical Center, New Brunswick, NJ
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Oversewing staple line of the gastric remnant in gastric bypass reduces postoperative bleeding. Ann Med Surg (Lond) 2021; 67:102534. [PMID: 34276984 PMCID: PMC8267426 DOI: 10.1016/j.amsu.2021.102534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/27/2021] [Accepted: 07/01/2021] [Indexed: 11/22/2022] Open
Abstract
Background Roux-en-Y gastric bypass (RYGB) is a surgery with low rate complications. However, it is not exempt from them, and 1–6% suffer complications such as postoperative bleeding. Many intraoperative techniques have been evaluated to reduce postoperative bleeding, like the oversewing or reinforcement of the staple line. This study aims to evaluate the rate of postoperative bleeding in the oversewing of the staple line of the gastric remnant group versus the stapling only group. Methods This is a 2-center, case-control study. We randomly selected two groups who underwent RYGB or OAGB: group A (n = 225) with oversewing from 2019 to 2020 and group B (n = 225) with stapling only between the period of 2017–2018; both groups with similar demographic characteristics. Results The overall mean age was 37.39 ± 9.6 years and mean BMI was 41.59 ± 8.6 kg/m2; the postoperative bleeding rate was significantly lower (p < 0,05) in patients with oversewing of the staple line of the gastric remnant. Operative time was shorter for the stapling only group and the difference between the mean operative time was 10.6 min. Conclusions Oversewing the staple line of the gastric remnant significantly reduces the incidence of postoperative bleeding regardless of BMI. Being a cost-effective technique compared to others available despite the increase in operating time. Postoperative bleeding represents an important complication in bariatric surgery, which involves high costs. Among the methods of reinforcement, the oversewing of the staple line represents a cost-effective technique. Reinforcement of the gastric remnant staple line can decrease postoperative bleeding without considerably increasing time.
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Optimizing detection of postoperative leaks on upper gastrointestinal fluoroscopy: a step-by-step guide. Abdom Radiol (NY) 2021; 46:3019-3032. [PMID: 33635362 DOI: 10.1007/s00261-021-02978-0] [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: 11/22/2020] [Revised: 01/22/2021] [Accepted: 02/09/2021] [Indexed: 11/27/2022]
Abstract
Postoperative leaks after gastrointestinal surgery are important to identify to decrease patient morbidity and mortality. Fluoroscopic studies are commonly employed to detect postoperative leak. While the literature addresses the sensitivity and specificity of these examinations, there is generally a lack of description of the fluoroscopic technique itself and there may be variability between radiologists in how these studies are performed. It is important to balance a standardized fluoroscopy protocol while tailoring the exam for each surgical and patient situation. Here we will briefly review common postoperative anatomy in the upper gastrointestinal tract, propose fluoroscopic techniques to improve postoperative leak detection, and illustrate teaching points with clinical cases.
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Baptiste-Castillo HF, Parra-Zuluaga R, Niño-Andrade F, Rodríguez-Sánchez S. Manejo quirúrgico de una fístula gastropleural posterior a manga gástrica. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Se presenta el caso de una paciente de 30 años de edad, sometida a un procedimiento de manga gástrica por laparoscopia en marzo de 2014, quien presenta, al tercer y cuarto años del procedimiento inicial, dos episodios de hemoptisis masiva, con falla en la segunda terapia de embolización, por lo que requirió una lobectomía pulmonar inferior izquierda. Al segundo día de este postoperatorio presenta salida de material de nutrición por las sondas de tórax, estableciéndose el diagnóstico de fistula gastro-pleural. Debido a falla con el manejo conservador, fue sometida a una resección quirúrgica de la fístula por vía laparoscópica, con gastrectomía proximal y reconstrucción en Y de Roux. A propósito de nuestra experiencia con esta paciente, se discuten en este artículo las estrategias de manejo para una fístula gastropleural, propuestas en la literatura a la fecha.
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Perioperative Practices Concerning Sleeve Gastrectomy - a Survey of 863 Surgeons with a Cumulative Experience of 520,230 Procedures. Obes Surg 2021; 30:483-492. [PMID: 31677017 DOI: 10.1007/s11695-019-04195-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Sleeve Gastrectomy (SG) is the most commonly performed bariatric procedure worldwide. There is currently no scientific study aimed at understanding variations in practices concerning this procedure. The aim of this study was to study the global variations in perioperative practices concerning SG. METHODS A 37-item questionnaire-based survey was conducted to capture the perioperative practices of the global community of bariatric surgeons. Data were analyzed using descriptive statistics. RESULTS Response of 863 bariatric surgeons from 67 countries with a cumulative experience of 520,230 SGs were recorded. A total of 689 (80%) and 764 (89%) surgeons listed 13 absolute and relative contraindications, respectively. 65% (n = 559) surgeons perform routine preoperative endoscopy and 97% (n = 835) routinely use intraoperative orogastric tube for sizing the resection. A wide variation is observed in the diameter of the tube used. 73% (n = 627) surgeons start dividing the stomach at a distance of 3-5 cm from the pylorus, and 54% (n = 467) routinely use staple line reinforcement. Majority (65%, n = 565) of surgeons perform routine intraoperative leak test at the end of the procedure, while 25% (n = 218) surgeons perform a routine contrast study in the early postoperative period. Lifelong multivitamin/mineral, iron, vitamin D, calcium, and vitamin B12 supplementation is advocated by 66%, 29%, 40%, 38% and 44% surgeons, respectively. CONCLUSION There is a considerable variation in the perioperative practices concerning SG. Data can help in identifying areas for future consensus building and more focussed studies.
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Complications associated with laparoscopic sleeve gastrectomy - a review. GASTROENTEROLOGY REVIEW 2021; 16:5-9. [PMID: 33986881 PMCID: PMC8112272 DOI: 10.5114/pg.2021.104733] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/06/2020] [Indexed: 12/26/2022]
Abstract
Laparoscopic sleeve gastrectomy (LSG) is an essential bariatric procedure performed in obese patients, which provides significant weight loss and has a positive impact on obesity-related diseases. However, as with any surgical procedure, it carries the risk of complications. The complications that can arise in patients following LSG are divided into acute (diagnosed within 30 days after the surgery) and late. Early complications that require rapid management include haemorrhage (intraluminal or extraluminal), leak in the staple line, and abscess formation. Late complications include gastric stenosis, nutrient deficiencies, mediastinal pouch migration, and the development or exacerbation of gastroesophageal reflux diseases. In this review, we present the basic information about most common complications following LSG, and their symptoms, diagnostic tools, and management.
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