1
|
Quezada N, Maiz C, Daroch D, Funke R, Sharp A, Boza C, Pimentel F. Effect of Early Use of Covered Self-Expandable Endoscopic Stent on the Treatment of Postoperative Stapler Line Leaks. Obes Surg 2016; 25:1816-21. [PMID: 25840555 DOI: 10.1007/s11695-015-1622-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Postoperative leaks are a dreaded complication after bariatric surgery (BS). Its treatment is based on nutritional support and sepsis control by antibiotics, collections drainage and/or prosthesis, and/or surgery. OBJECTIVES The aim of this study is to report our experience with coated self-expandable endoscopic stents (SEES) for leaks treatment. SETTING This study was performed in a University Hospital, (censored). METHODS We performed a retrospective analysis of our BS database from January 2007 to December 2013. All patients with leak after BS treated with SEES were included. RESULTS We identified 29 patients; 17 (59%) were women, with median age of 37 (19-65) years, and preoperative body mass index of 40 (28.7-56-6) kg/m(2). Nineteen (65.5%) patients had a sleeve gastrectomy and 10 (34.5%) a Roux-en-Y gastric bypass. All patients had a leak in the stapler line. Median time from surgery to leak diagnosis was 7 (1-51) days, and SEES were installed 8 (0-104) days after diagnosis. Twenty-one (72%) patients also had abdominal exploration. Median length of SEES use was 60 (1-299) days. Patients who had SEES as primary treatment (with or without simultaneous reoperation) had a shorter leak closure time (50 [6-112] vs 109 [60-352] days; p = 0.008). Twenty-eight (96.5%) patients successfully achieved leak closure with SEES. There were 16 migrations in 10 (34%) patients, 1 (3%) stent fracture, 1 opening of the blind end of alimentary limb (3%), and 5 patients (17%) required a second stent due to leak persistence. CONCLUSIONS SEES is a feasible, safe, and effective management of post BS leaks, although patients may also require prosthesis revision and abdominal exploration. Primary SEES placement is associated with a shorter leak resolution time.
Collapse
Affiliation(s)
- Nicolás Quezada
- Department of Digestive Surgery. School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, patio interior, División de Cirugía, Región Metropolitana, Santiago, Chile,
| | | | | | | | | | | | | |
Collapse
|
2
|
Maldonado C, Daroch D, Maiz C, Bachler J, Crovari F, Boza C, Funke R, Köckerling F, Dabic D, Maric B, Perunicic V, Aho J, Samaha M, Antiel R, Dupont S, Ballman K, Sloan J, Bingener J, Macano C, Brookes A, Samee A, Davies S, Haleem A, Hayden S, Al-Aaraji S, Beardsmore D, Cox T, Huntington C, Blair L, Prasad T, Augenstein V, Heniford BT, Bauder A, Fischer J, Kovach S. Topic: Abdominal Wall Hernia - Epigastric hernia: choice of approach, repair, results, follow up. Hernia 2015; 19 Suppl 1:S208-11. [PMID: 26518802 DOI: 10.1007/bf03355351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- C Maldonado
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - D Daroch
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - C Maiz
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - J Bachler
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - F Crovari
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - C Boza
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - R Funke
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - D Dabic
- Department of surgery, General Hospital Cacak, Cacak, Serbia
| | | | | | - J Aho
- Mayo Clinic, Rochester, USA
| | | | | | | | | | | | | | - C Macano
- University Hospital of North Staffordshire, Stoke-on-Trent, UK
| | | | | | | | | | | | | | | | - T Cox
- Department of GI and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, USA
| | - C Huntington
- Department of GI and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, USA
| | - L Blair
- Department of GI and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, USA
| | - T Prasad
- Department of GI and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, USA
| | - V Augenstein
- Department of GI and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, USA
| | - B T Heniford
- Department of GI and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, USA
| | - A Bauder
- Hospital of the University of Pennsylvania, Philadelphia, USA
| | - J Fischer
- Hospital of the University of Pennsylvania, Philadelphia, USA
| | - S Kovach
- Hospital of the University of Pennsylvania, Philadelphia, USA
| |
Collapse
|
3
|
León F, Maiz C, Daroch D, Quezada N, Gabrielli M, Muñoz C, Boza C. Laparoscopic hand-sewn revisional gastrojejunal plication for weight loss failure after Roux-en-Y gastric bypass. Obes Surg 2015; 25:744-9. [PMID: 25618780 DOI: 10.1007/s11695-014-1463-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Revisional surgery has become a widely accepted alternative for weight loss failure/regain after bariatric surgery. However, it is associated to higher morbi-mortality and lesser weight loss than primary bariatric procedure. Our aims are to present a novel technique for weight loss treatment after failed laparoscopic Roux-en-Y gastric bypass (LRYGB) and to report its short-term results. METHODS This is a retrospective analysis of patients submitted to a revisional hand-sewn double-layer gastrojejunal plication (GJP) for treatment of weight loss failure/regain after LRYGB. Analysis of demographics, body mass index (BMI), and percentage of excess weight loss (%EWL) at the 6th month complications, and financial costs involved was included. RESULTS Four patients were submitted to revisional GJP. Three patients were female and the mean age at revision was 30 ± 9 years (21-44). The median time interval between LRYGB and GJP was 51 months (24-120). The median BMI at the moment of GJP and the 3rd and 6th month was 35.6 kg/m2 (32.0-37.8), 32.2 kg/m2 (29.7-34.1), and 30.7 kg/m2 (28.1-32.1), respectively. The median %EWL at the 3rd and 6th month was 35.4% (13.6-38.9) and 46.2 % (45.1-55.5), respectively, reaching a cumulative (combined surgeries) %EWL of 62.9% (16.5-67.9) and 71.7% (65.1-77.6), respectively. There were no complications or mortality. Financial costs were significantly lower compared to revisional gastrojejunal stapled reduction (US $1400 cheaper). CONCLUSION Revisional GJP is a feasible, safe, and cost-effective novel procedure for treatment of weight loss failure/regain after LRYGB. Mid- and long-term results are necessary in order to establish its real effectiveness.
Collapse
Affiliation(s)
- Felipe León
- Bariatric Surgery Unit, Digestive Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, patio interior, División de Cirugía, Región Metropolitana, Santiago, Chile,
| | | | | | | | | | | | | |
Collapse
|
4
|
Maldonado C, Daroch D, Funke R, Jarufe N, Gabrielli M, Gorganchian F, Santa Maria V, Dupuy Cash T, Mori I, Anania S. Topic: Abdominal Wall Hernia — Epigastric hernia: choice of approach, repair, results, follow up. Hernia 2015; 19 Suppl 1:S343. [DOI: 10.1007/bf03355383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
5
|
Boza C, Daroch D, Barros D, León F, Funke R, Crovari F. Long-term outcomes of laparoscopic sleeve gastrectomy as a primary bariatric procedure. Surg Obes Relat Dis 2014; 10:1129-33. [PMID: 25500284 DOI: 10.1016/j.soard.2014.03.024] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 03/11/2014] [Accepted: 03/26/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has been established as a reliable bariatric procedure, but questions have emerged regarding its long-term results. Our aim is to report the long-term outcomes of LSG as a primary bariatric procedure. METHODS Retrospective analysis of patients submitted to LSG between 2005 and 2007 in our institution. Long-term outcomes at 5 years were analyzed in terms of body mass index (BMI), excess weight loss (EWL) and co-morbidities resolution. Surgical success was defined as %EWL>50%. Also, we compared long-term results according to preoperative BMI, using Mann-Whitney test. RESULTS A total of 161 LSG were analyzed, and 114 patients (70.8%) were women. The median age was 36 years old (range 16-65), median preoperative BMI was 34.9 kg/m(2) (interquartile range [IQR], 33.3-37.5). A total of 112 patients (70%) completed 5 years of follow-up. At the fifth year, median BMI and %EWL was 28.5 kg/m(2) (IQR: 25.8-31.9) and 62.9% (IQR: 45.3-89.6), respectively, with a surgical success of 73.2% of followed patients. According to preoperative BMI, surgical success was achieved in 80% of patients with BMI<35 kg/m(2), 75% of BMI 35-40 kg/m(2), and 52.6% of BMI>40 kg/m(2), with significant lower %EWL in patients with BMI>40 kg/m(2) (P = .001 and .004). Dyslipidemia and insulin resistance resolution was 80.7% and 84.7%, respectively. A total of 26.7% of patients reported new-onset gastroesophageal reflux symptoms at 5 years. CONCLUSION LSG as a primary procedure is a reliable surgery. We observed positive long-term outcomes of %EWL and co-morbidities resolution. In our series, best results are seen in patients with preoperative BMI<40 kg/m(2).
Collapse
Affiliation(s)
- Camilo Boza
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - David Daroch
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Diego Barros
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe León
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ricardo Funke
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fernando Crovari
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|