Earliest signs and management of leakage after bariatric surgeries: Single institute experience

Bekheit, Mohamed; Katri, Khaled; Nabil, Wael; Sharaan, Mohamed; Kayal, El Said A. El

doi:10.1016/j.ajme.2012.09.004

Cited by 19 publications

(14 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We acknowledge that the cost of this extra imaging increases the cost of our stapleless technique; however, we felt that it was warranted in our initial series to be skeptical. Although our patients were closely monitored for clinical signs of early leak such as tachycardia, fever, and unequal inspiration [ 7 ], we note that these signs are not specific to leakage and could indicate atelectasis, which is recognized as the most common complication in bariatric patients [ 32 ]. Dehydration also causes low-grade pyrexia and tachycardia and could have confounded the diagnosis of an early leak.…”

Section: Resultsmentioning

confidence: 99%

“…After identifying high rates of leakage in our cohorts, we considered technical modifications to minimize complications. We previously reviewed the leakage rate after different bariatric procedures, and identified post-operative leaks were highest in patients post LSG [ 7 ]. This led to a series of modifications that resulted in a significant reduction in the leakage rate [ 8 ].…”

Section: Methodsmentioning

confidence: 99%

“…A leak test with diluted methylene blue was performed, and a tube drain was left adjacent to the gastric pouch [ 8 ]. Since early leakage usually presents with subtle symptoms [ 7 ], a post-operative computed tomography (CT) with oral contrast was routinely adopted in this series (at 30–48 h post-op), to verify the absence of leak and demonstrate the appropriate size of the pouch (Fig. 4 b, c).…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Stapleless Laparoscopic Sleeve Gastrectomy: Reasoning and Technical Insights

2017

Self Cite

View full text Add to dashboard Cite

BackgroundLaparoscopic sleeve gastrectomy (LSG) with staple line reinforcement (SLR) is a popular and safe treatment option for morbid obesity. We have developed, devised, and described our own method of stapleless laparoscopic sleeve gastrectomy, which in our limited study appeared safe, efficacious, and potentially cost-effective.MethodsWe analyzed the outcome of our modified LSG in a case series of three middle-aged women (median age 42 years old). Our main modification was sutured closure of the stomach rather than the commonly utilized technique of stapled closure. Our primary measure of success was the occurrence of post-operative leak. Secondary measures were (a) length of operation, (b) duration of inpatient stay, and (c) percentage of weight loss at 6 and 12 months post operation.ResultsMedian operative time = 132 min (120–195 min), and median inpatient stays were 2 days. No post-operative leaks were recorded. The median excess weight loss at 6 months was 39% of initial weight loss and 57.7% at 12 months.ConclusionsStapleless LSG has the potential to be an affordable alternative to the traditional LSG. High-powered studies and a formal cost analysis are required.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Stapleless Laparoscopic Sleeve Gastrectomy: Reasoning and Technical Insights

2017

Self Cite

View full text Add to dashboard Cite

show abstract

“…This perhaps is the reason why gastrografin swallow tests performed in patients with a clinically suspected leak are commonly false negative. [ 13 14 15 ]…”

Section: Discussionmentioning

confidence: 99%

Management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity: A tertiary care experience and design of a management algorithm

et al. 2016

View full text Add to dashboard Cite

BACKGROUND:Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed ‘standalone’ bariatric procedure in India. Staple line gastric leaks occur infrequently but cause significant and prolonged morbidity. The aim of this retrospective study was to analyse the management of patients with a gastric leak after LSG for morbid obesity at our institution.PATIENTS AND METHODS:From February 2008 to 2014, 650 patients with different degrees of morbid obesity underwent LSG. Among these, all those diagnosed with a gastric leak were included in the study. Patients referred to our institution with gastric leak after LSG were also included. The time of presentation, site of leak, investigations performed, treatment given and time of closure of all leaks were analysed.RESULTS:Among the 650 patients who underwent LSG, 3 (0.46%) developed a gastric leak. Two patients were referred after LSG was performed at another institution. The mean age was 45.60 ± 15.43 years. Mean body mass index (BMI) was 44.79 ± 5.35. Gastric leak was diagnosed 24 h to 7 months after surgery. One was early, two were intermediate and two were late leaks. Two were type I and three were type II gastric leaks. Endoscopic oesophageal stenting was used variably before or after re-surgery. Re-surgery was performed in all and included stapled fistula excision (re-sleeve), suture repair only or with conversion to roux-en-Y gastric bypass or fistula jujenostomy. There was no mortality.CONCLUSION:Leakage closure time may be shorter with intervention than expectant management. Sequence and choice of endoscopic oesophageal stenting and/or surgical re-intervention should be individualized according to clinical presentation.

show abstract

“…88 Early complication rates (< 30 days) after bariatric surgery were reported to be < 10% 73,94 and tended to be lower in restrictive surgeries compared with in hybrid surgeries. 50,73 Most common early complications reported are gastric and anastomosis leak (1.6% to 5.1%), 73,95,96 bleeding (0.5% to 3.5%), 50,73,97 and pulmonary embolism (0.2% to 1.0%). 52,73,98 Longterm complications (> 30 days) might differ depending on the type of bariatric surgery.…”

Section: Mortalitymentioning

confidence: 98%