Complications associated with laparoscopic sleeve gastrectomy for morbid obesity: a surgeon’s guide

Sarkhosh, Kourosh; Birch, Daniel W.; Sharma, Arya M.; Karmali, Shahzeer

doi:10.1503/cjs.033511

Cited by 166 publications

(118 citation statements)

References 26 publications

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“…Some of the complications that can come with doing LSG include hemorrhage, staple line leak, abscess formation, and strictures. The source of the bleeding for hemorrhages can be intraluminal or extraluminal; symptoms include hematemesis or melena stools [13]. Staple line leaks are some of the more serious complications of LSG; and can occur in up to 5% of patients [14].…”

Section: Discussionmentioning

confidence: 99%

A Sleeve Gastrectomy Complicated by Mesenteric Vein Thrombosis, Abdominal Compartment Syndrome and Pulmonary Emboli: Case Report

Leung¹,

Sorensen²

2015

Int J Biomed

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Background: Obesity is a growing problem all over the world, including the United States. Single-incision laparoscopic sleeve gastrectomy is a surgery performed for patients who want to lose weight. The number of deaths resulting from thromboembolic complications from bariatric surgeries continues to be of major concern.Case Description: A 38-year-old female was admitted for single incision sleeve gastrectomy and was discharged home three days later. Subsequently she began to have abdominal pain, nausea and vomiting. A CT scan revealed superior mesenteric vein thrombosis with small bowel ischemia, splenic infarction and main and right portal vein branch thrombosis. An exploratory laparotomy demonstrated necrotic bowel due to abdominal compartment syndrome, and an area of small bowel was resected due to internal hernia. Surgical management of the patient during her second hospital stay included a decompressive laparotomy, internal hernia reduction, a small bowel resection.Discussion: Superior mesenteric vein thrombosis can be a life-threatening complication and present with non-specific presentations; thus, it is imperative that it is identified and managed promptly as these cases carry significant morbidity and mortality. Obese patients who undergo bariatric surgery frequently have other co-morbidities; many of which can complicate a case further. Mesenteric vein thrombosis is normally treated with unfractionated or low-molecular-weight heparin. (Int J Bopmed. 2015;5(3):162-166.)

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Section: Discussionmentioning

confidence: 99%

A Sleeve Gastrectomy Complicated by Mesenteric Vein Thrombosis, Abdominal Compartment Syndrome and Pulmonary Emboli: Case Report

Leung¹,

Sorensen²

2015

Int J Biomed

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“…Genişleyebilen 10 SHK olan hastalarda kaçağın ilk 3 günde tespit edilmesi durumunda laparoskopik olarak onarılması ilk tercih edilen yöntemdir. 11 Ancak geç tespit edilen olgularda inflamasyonun yol açtığı anatomik değişiklikler onarımı zorlaştırabilir. Bu olgularda uygun seçenek drenaj, stent yerleştirilmesi ve antibiyoterapidir.…”

Section: Cerrahi̇ Tekni̇kunclassified

Treatment Of Staple Line Leaks After Laparoscopic Sleeve Gastrectomy With Self-Expandable Metalic Stents

Ece¹,

Yılmaz²,

Alptekın³

et al. 2016

Turkiye Klinikleri J Med Sci

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Ö ÖZ ZE ET T A Am ma aç ç: : Laparoskopik sleeve gastrektomi (LSG) kilo kaybı ve obezite ilişkili hastalıkların tedavisinde etkili bir bariatrik yöntemdir. LSG'nin en önemli komplikasyonu stapler hattı kaçakları-dır (SHK). Dörtyüz yirmi iki LSG olgusu içeren bu çalışmada SHK oranı ve tedavi yönetimi tartışılacaktır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Dörtyüz yirmi iki hastaya Ocak 2010-Haziran 2015 tarihleri arasında LSG uygulandı. Bir üniversite hastanesi obezite cerrahisi kliniğinde LSG sonrası kaçak teş-hisi konulan hastalar retrospektif olarak incelendi. Mide rezeksiyonu pilordan 4-6 cm mesafeden 60 mm stapler yardımı ile yapıldı. Mide tüpü 36F buji ile kalibre edildi. Stapler hattı rutin olarak devamlı dikişlerle kuvvetlendirildi. SHK gelişen hastalar genişleyebilen stentler ile tedavi edildi. B Bu ul lg gu ul la ar r: : Hastaların ortalama yaşı 41.8 (29-55) yıl ve kadın/erkek oranı 7/5 idi. Ortalama beden kitle indeksi 44.1 kg/m2 olan hastalardan birisinde gastrik band ameliyatı hikayesi vardı. Stapler hattı kaçak oranı 12/422 (%2.8) idi. Tüm olgularda kaçak alanı gastroözofajiyal bileşke komşulu-ğunda idi. SHK endoskopik genişleyebilen stent uygulaması ile tedavi edildi. Tüm hastalarda parenteral beslenme ve antibiyotikleri içeren medikal destek sağlandı. Tüm olgularda stent yerleştirilmesi başarılı bir tedavi sağladı. S So on nu uç ç: : Laparoskopik sleeve gastrektomide SHK en sık gö-rülen komplikasyon olup tüm komplikasyonların yarısını oluşturur. Genişleyebilen stent uygulaması, antibiyotik ve parenteral beslenme ile birleştirildiğinde etkili sonuçlar elde edilebilir ve durumu stabil hastalarda ilk tedavi basamağı olmalıdır.A An na ah ht ta ar r K Ke el li im me el le er r: : Laparoskopi; obezite, morbid; anastomotik sızıntı; stentler A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric procedure on weight loss and obesity-related comorbidities. The most important complication of LSG is the staple line leaks (SLL). This study aims to report the SLL rate and its management with self-expandable stent in a series of 422 LSGs. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : A total of 422 patients underwent LSG from January 2010 to June 2015. A retrospective study was performed to the patients who were diagnosed as staple line leak at department of obesity surgery of a university hospital. The gastric resection was started from the antrum with a distance of 4-6 cm to the pilorus, by a 60mm staples. A 36F bougie was used to calibrate the gastric tube. The staple line was routinely reinforced with running sutures. The patients who developed SLL were treated endoscopically with self-expandable metalic stent (SEMS) placement. R Re es su ul lt ts s: : The mean age of patients were 41.8 (29-55) years, and female/male ratio was 7/5. Mean body mass index of 44.1 kg/m2 in patients, one of the cases has a gastric banding history. SLL rate was 12/422 (2.8%). Leak area was near the gastroesophageal junction in all cases. ...

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“…SG leaks are feared complications due to be leaks of high pressure, taking much longer to close than RYGB leaks, and being causes of prolonged hospitalization, and high morbidity. Overall SG leaks occur at the angle of Hiss, due to excessive narrowing of the gastrectomyat the incisura angularis, which can raise the pressure, initiating the leak (13,43).…”

Section: Surgical Complicationsmentioning

confidence: 99%

Bariatric surgery – An update for the endocrinologist

Mancini

2014

Arq Bras Endocrinol Metab

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Obesity is a major public health problem, is associated with increased rates of mortality risk and of developing several comorbidities, and lessens life expectancy. Bariatric surgery is the most effective treatment for morbidly obese patients, reducing risk of developing new comorbidities, health care utilization and mortality. The establishment of centers of excellence with interdisciplinary staff in bariatric surgery has been reducing operative mortality in the course of time, improving surgical safety and quality. The endocrinologist is part of the interdisciplinary team. The aim of this review is to provide endocrinologists, physicians and health care providers crucial elements of good clinical practice in the management of morbidly obese bariatric surgical candidates. This information includes formal indications and contraindications for bariatric operations, description of usual bariatric and metabolic operations as well as endoscopic treatments, preoperative assessments including psychological, metabolic and cardiorespiratory evaluation and postoperative dietary staged meal progression and nutritional supplementation follow-up with micronutrient deficiencies monitoring, surgical complications, suspension of medications in type 2 diabetic patients, dumping syndrome and hypoglycemia. Arq Bras Endocrinol Metab. 2014;58(9):875-88 Keywords Bariatric surgery; Roux-en-Y gastric bypass; biliopancreatic diversions; obesity; weight loss RESUMO A obesidade é um problema de saúde pública, está associada com aumento do risco de mortalidade e de desenvolver diversas comorbidades e diminui a expectativa de vida. A cirurgia bariátrica é o tratamento mais eficaz para pacientes com obesidade mórbida, reduzindo o desenvolvimento de novas comorbidades, a utilização dos cuidados de saúde e a mortalidade. A criação de centros de excelência com equipes interdisciplinares em cirurgia bariátrica vem reduzindo a mortalidade operatória no decorrer do tempo, melhorando a segurança e a qualidade cirúrgica. O endocrinologista faz parte da equipe interdisciplinar. O objetivo desta revisão é fornecer aos endocrinologistas, médicos e prestadores de cuidados de saúde elementos cruciais de boas práticas clínicas no tratamento de pacientes com obesidade mórbida candidatos à cirurgia bariátrica. Essas informações incluem indicações formais e contraindicações para as operações bariátricas, descrição das operações bariátricas e metabólicas habituais, bem como tratamentos endoscópicos, avaliação pré-operatória, incluindo avaliação cardiorrespiratória psicológica, metabólica e no pós-operatório, dieta com refeições progressivamente estagiadas e seguimento com suplementação nutricional e monitoramento de deficiências de micronutrientes, complicações cirúrgicas, suspensão de medicamentos em pacientes diabéticos tipo 2, síndrome de dumping e hipoglicemia. Arq Bras Endocrinol Metab. 2014;58(9):875-88 Descritores Cirurgia bariátrica; bypass gástrico em Y de Roux; desvios biliopancreáticos; obesidade; perda de peso

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Complications associated with laparoscopic sleeve gastrectomy for morbid obesity: a surgeon’s guide

Cited by 166 publications

References 26 publications

A Sleeve Gastrectomy Complicated by Mesenteric Vein Thrombosis, Abdominal Compartment Syndrome and Pulmonary Emboli: Case Report

A Sleeve Gastrectomy Complicated by Mesenteric Vein Thrombosis, Abdominal Compartment Syndrome and Pulmonary Emboli: Case Report

Treatment Of Staple Line Leaks After Laparoscopic Sleeve Gastrectomy With Self-Expandable Metalic Stents

Bariatric surgery – An update for the endocrinologist

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