A very challenging leak from a sleeve gastrectomy (original) (raw)
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Nonsurgical Treatment of Staple Line Leaks after Laparoscopic Sleeve Gastrectomy
Obesity Surgery, 2009
Background Laparoscopic sleeve gastrectomy (LSG) is gaining popularity as a "per se" bariatric procedure due to its effectiveness on weight loss and comorbidity resolution. The most feared and life-threatening complication after LSG is the staple line leak and its management is still a debated issue. Aim of this paper is to analyze the incidence of leak and the treatment solutions adopted in a consecutive series of 200 LSG. Methods From
2020
Introduction. Aim of the study was trying to draw a final flow chart for the management of gastric leaks after laparoscopic sleeve gastrectomy, based on the review of our cases over 10 years' experience. Material and Methods. We retrospectively reviewed all patients who underwent LSG as a primary operation at the Bariatric Unit of Tor Vergata University Hospital in Rome from 2007 to 2015. Results. Patients included in the study were 418. There were 6 staple line leaks (1.44%). All patients with diagnosis of a leak were initially discharged home in good clinical conditions and then returned to A&E because of the complication. The mean interval between surgery and readmission for leak was 13,4 days (range 6-34 days, SD ± 11.85). We recorded one death (16.67%) due to sepsis. The remaining five cases were successfully treated with a mean healing time of the gastric leak of 55,5 days (range 26-83 days; SD ± 25.44). Conclusion. Choosing the proper treatment depends on clinical stabil...
Management of staple line leaks following sleeve gastrectomy
Surgery for Obesity and Related Diseases, 2014
Background: Leaks after laparoscopic sleeve gastrectomy (LSG) are not very frequent but are a difficult complication that can become chronic. Various treatment options have been suggested but no definitive treatment regimen has been established. The aim of our study is to report leak complications after LSG, their management, and outcomes. Methods: Between June 2008 and October 2013, a total of 539 patients underwent laparoscopic and robot-assisted laparoscopic sleeve gastrectomy at our institution. A retrospective review of a prospectively collected database was performed for all LSG patients, noting the outcomes and complications of the procedure. Results: Fifteen (2.8%) patients presented with a leak after LSG. The diagnosis was made at a mean of 27.2 Ϯ 29.9 days (range, 1-102) after LSG. Eight (53.3%) patients underwent conservative treatment initially and 6 (75.0%) of these patients required stenting as secondary treatment. Although leaks from 3 patients resolved with stenting, the other 3 required restenting and 2 eventually underwent conversion to gastric bypass. Five (33.3%) patients underwent endoscopic intervention, closing the leak with fibrin glue (n ¼ 3) or hemoclips (n ¼ 2). Two (13.3%) patients who were diagnosed with a leak immediately after LSG before discharge had their leak oversewn laparoscopically with an omental patch. Leaks in 9 (60.0%) patients did not heal after the first intervention, and the mean number of intervention required was 2.3 Ϯ 1.7 times (range, 1-7) for the treatment of this condition. Conclusion: Management of leaks after LSG can be challenging. Early diagnosis and treatment is important in the management of a leak. However, it can be treated safely via various management options depending on the time of diagnosis and size of the leak.
Integrated Approaches for the Management of Staple Line Leaks following Sleeve Gastrectomy
Journal of Obesity, 2017
Introduction. Aim of the study was trying to draw a final flow chart for the management of gastric leaks after laparoscopic sleeve gastrectomy, based on the review of our cases over 10 years’ experience. Material and Methods. We retrospectively reviewed all patients who underwent LSG as a primary operation at the Bariatric Unit of Tor Vergata University Hospital in Rome from 2007 to 2015. Results. Patients included in the study were 418. There were 6 staple line leaks (1.44%). All patients with diagnosis of a leak were initially discharged home in good clinical conditions and then returned to A&E because of the complication. The mean interval between surgery and readmission for leak was 13,4 days (range 6–34 days, SD ± 11.85). We recorded one death (16.67%) due to sepsis. The remaining five cases were successfully treated with a mean healing time of the gastric leak of 55,5 days (range 26–83 days; SD ± 25.44). Conclusion. Choosing the proper treatment depends on clinical stability a...
Definitive surgical management of staple line leak after sleeve gastrectomy
Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery, 2015
Sleeve gastrectomy (SG) has become a widely adopted bariatric surgical procedure. The most serious complication is staple line leak (SLL), which is potentially life threatening and, in some patients, becomes chronic and difficult to manage. Definitive surgical management of SLL is effective but seldom published in the literature. This study aims to review the outcome of definitive surgical management of SLL after SG, looking at short-term and long-term results. Single surgeon experience based at a tertiary university hospital in Beirut, Lebanon. Retrospective review of records of patients with SLL who underwent definitive surgical treatment by the senior author (B.Y.S.) from January 2008 until December 2013. Ten patients (50% female) underwent definitive surgical repair during the study period. The mean age, weight, and body mass index at the time of SG were 35 years, 121 kg, and 41.5 kg/m(2), respectively. Most leaks (90%) were at the esophagogastric junction. All underwent multipl...
Surgery for Obesity and Related Diseases, 2013
Background: Laparoscopic sleeve gastrectomy (LSG) is an approved primary procedure for morbid obesity, but it is associated with serious complications, such as staple line leaks and bleeding. The objective of this study was to assess the effectiveness of staple line reinforcement (SLR) in reducing leaks and bleeding after LSG. Methods: A total of 1162 patients underwent LSG (305 males, 857 females). The mean age was 43.7 years and the mean body mass index was 48 kg/m 2 . The patients were divided into 6 groups based on the type of SLR, including a no-SLR control group, with evaluation of leaking and bleeding risk and correlation of patients' characteristics with complications. Results: A total of 189 patients underwent LSG without reinforcement. The SLR method was oversewing in 476 patients, bovine pericardium in 312, synthetic polyester in 76, glycolide/trimethylene copolymer in 63, and thrombin matrix in 46. The overall leak frequency was 2.8%; higher with synthetic polyester (7.8%), 4.8% with no reinforcement, and lower with bovine pericardium strips (.3%; P o .01). Postoperative hemorrhage occurred in 35 patients (3%), with a higher frequency being observed without SLR (13.7%; P ¼ .02). Only diabetes was a risk-factor for a leak (P o .01). Conclusion: SLR with bovine pericardium strips significantly reduced the leak risk. Postoperative bleeding was significantly lower with all SLR-methods, although there was no significant difference among the various techniques. Patients with type II diabetes had a higher risk of staple line leak after LSG. Further randomized, controlled studies are needed to improve our understanding of the efficacy of SLR during LSG. (Surg Obes Relat Dis 2013;]:00-00.) r
Obesity Surgery, 2010
Background Laparoscopic sleeve gastrectomy (LSG) is gaining acceptance among bariatric surgeons as a viable option for treating morbidly obese patients. We describe results of a single surgeon's experience with LSG in a community practice revealing a low complication rate and describing the surgical technique. Methods LSG was performed in 529 consecutive patients from December 2006 to March 2010. A technique is described where all operations were performed with attention to avoiding strictures at the incisura angularis and stapling close to the esophagus at the angle of His. No operations performed used buttressing material or oversewing of the staple line. A retrospective chart review and e-mail survey was conducted to determine the occurrence of complications and weight loss. Results Follow-up data was collected on 490 of the 529 (92.6%) patients at 6 weeks. A total complication rate of 3.2% and a 1.7% 30-day readmission rate were observed. No leaks occurred in any of the 529 patients, and one death (0.19%) was observed. The most common complications were nausea and vomiting with dehydration and venous thrombosis. The percentages of excess weight loss were 42.36, 65.92, 66.11, and 64.42 with a follow-up of 71%, 68%, 63%, and 49% at 6 months, 1 year, 2, and 3 years, respectively. Conclusion The LSG can be performed in a community practice with a low complication rate. Surgeons performing LSG should strive to minimize the risk of creating strictures at the incisura angularis and stapling near the esophagus at the angle of His.
Late Complication of Laparoscopic Sleeve Gastrectomy
Case Reports in Gastrointestinal Medicine, 2013
Laparoscopic sleeve gastrectomy (LSG) is gaining popularity for the treatment of morbid obesity. It is a simple, low-cost procedure resulting in significant weight loss within a short period of time. LSG is a safe procedure with a low complication rate. The complications encountered nevertheless can result in morbidity and even mortality. The most significant complications are staple-line bleeding, stricture, and staple-line leak. The purpose of this paper is to present a patient who suffered from a staple-line leak presenting 16 months after LSG. Review of the current literature regarding this complication as well as outline of a strategy for the management of post-LSG gastric leaks is suggested.
Laparoscopic Sleeve Gastrectomy Leakage: Case Report of A Rare Complication Management Citation
Introduction: Laparoscopic sleeve gastrectomy (SG) is an effective method for the treatment of obesity. Leakage is the most common and unfavorable complication of SG. Use of self-expandable metal stents (SEMS) has become the gold standard management. Aortoesophageal fistula (AEF) is a rare and life-threatening complication that can result from SEMS placement. Case Presentation: A 52 year-old woman underwent laparoscopic SG for morbid obesity. Eight days after an esophagogastric SEMS placement was required for gastric leakage. Twenty-two days later she presented massive hematemesis and active AEF was diagnosed requiring endovascular placement of thoracic endoprosthesis. SG conversion into Roux-en-Y gastric bypass (RYGB) with double pigtail stent placement was necessary for the persistence of gastric fistula. 45 days after, EGD revealed the aortic prosthesis at the distal portion of esophagus. For this reason, she underwent a thoracic aorta reconstruction and an esophago-jejunal anastomosis. Discussion: Esophageal ulceration is a possible complication of SEMS placement and can lead to an AEF. In order to promptly identify and treat rare and fatal complications as AEF, it is important to always keep a high index of suspicion. facilitate immediate surgical treatment and to raise survival possibility. It is important to be familiar with all different treatment options, as well as being updated on the latest Guidelines. A good knowledge of timing and best treatment option, depending on the leak and patient clinical status, are mandatories.
Journal of Metabolic and Bariatric Surgery
Obesity has been considered a chronic relapsing disease. The increasing number of obese individuals has resulted in an increase in the demand for bariatric surgeries annually. Post-laparoscopic sleeve gastrectomy complications are challenging for both patients and surgeons. Thus, this paper reviews the most common and significant risk factors for leakage occurrence after laparoscopic sleeve gastrectomy and presents new tools, techniques, management options, and recommendations, gathered from newly published articles, for post-laparoscopic sleeve gastrectomy leakage. Causes of post-laparoscopic sleeve gastrectomy leakage include technical factors such as bougie size, transection point, reinforcement materials, and patient co-morbidities as well as ischemic reasons. Ischemic leakage, which is most commonly seen in laparoscopic sleeve gastrectomy, occurs usually after the fourth day, although some leakage may appear earlier within 1-3 days due to technical issues. Use of varied bougie sizes results in similar excess weight loss % at the one-year follow-up. Buttressing materials also reduce post-laparoscopic sleeve gastrectomy bleeding, but not the leakage rate. Endoscopic stents play a significant role in gastric leakage treatment in post-laparoscopic sleeve gastrectomy patients. Intra-operative or even early postoperative diagnostic tools can help in detecting early leaks, but minor leaks as well as those due to ischemic causes may be missed. In conclusion, laparoscopic sleeve gastrectomy is still one of the most effective bariatric surgeries, exhibiting approximately 70% excess weight loss. Although complications of post-laparoscopic sleeve gastrectomy are severe and may be life-threatening, most patients can be treated conservatively. However, those with persistent fistula require surgical intervention.