Gastric leakage after sleeve gastrectomy—clinical presentation and therapeutic options

Jurowich, Christian; Thalheimer, Andreas; Seyfried, Florian; Fein, Martin; Bender, G.; Germer, Christoph‐Thomas; Wichelmann, C

doi:10.1007/s00423-011-0800-0

Cited by 86 publications

(49 citation statements)

References 30 publications

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“…According to the time of onset, Csendes et al [6] classified leakage as early when appearing within the first four postoperative days, intermediate when appearing in postoperative days [5][6][7][8][9] and late when occurring in or after the tenth postoperative day. By clinical presentation and extent of dissemination, type I or subclinical leakage was defined as well localized leak without dissemination into the pleural or abdominal cavity and without systemic clinical manifestations, and usually they are easy to treat medically.…”

Section: Leak Classificationmentioning

confidence: 99%

“…It can also be an effluent of gastrointestinal contents through a suture line, which may collect near the anastomosis, or exit through the wall or the drain [4]. Leak is the second most common cause of death after bariatric surgery with an overall reported mortality rate of 0.4 % [5]. The aim here is to overview the current pathogenic and favoring factors of leakage after LSG on the basis of recent literature evidence and to summarize the suitable evidences and preventive measures according to the Oxford centre for evidence-based medicine (2011) evidence levels (EL).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors

Iossa

Abdelgawad

Watkins

et al. 2016

Langenbecks Arch Surg

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This review reports factors promoting leak and gives technical recommendations to avoid leak after LSG based on the available evidence and expert consensus which encompasses: (1) use a bougie size ≥40 Fr, EL:1, (2) begin the gastric transection 5-6 cm from the pylorus, EL:2-3, (3) use appropriate cartridge colors from antrum to fundus, EL:1, (4) reinforce the staple line with buttress material, EL:1, (5) follow a proper staple line, (6) remove the crotch staples, EL:4, (7) maintain proper traction on the stomach before firing, (8) stay away from the angle of His at least 1 cm, EL:1, (9) check the bleeding from the staple line, (10) perform an intraoperative methylene blue test, EL:4.

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Section: Leak Classificationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors

Iossa

Abdelgawad

Watkins

et al. 2016

Langenbecks Arch Surg

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“…Following the development of a fistula, the tissue surrounding the fistula orifice is friable and edematous due to inflammation with consequent ineffectiveness of surgical sutures at that location to close the fistula orifice [3,9], ultimately requiring total gastrectomy in some patients [4]. As these patients are often seriously ill with sepsis, a second major surgery often results in severe stress with a consequent higher risk of mortality [14].…”

Section: Discussionmentioning

confidence: 99%

“…The management of these fistulas is usually difficult and results in prolonged hospitalization. In the past, patients were re-operated with surgical attempts at closing the fistulas often ending in failure and total gastrectomy [2,9]. Several studies have shown the importance and efficacy of an endoscopic approach which is minimally invasive for the management of these complications, thus avoiding the risks of surgical re-intervention [3,10].…”

Section: Introductionmentioning

confidence: 99%

Fistula Recurrence: A Clinical Reality after Successful Endoscopic Closure of Laparoscopic Sleeve Gastrectomy Fistulas

Sousa

Ferreira

Coutinho

et al. 2018

GE Port J Gastroenterol

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Background and Aims: Laparoscopic sleeve gastrectomy (LSG)-related fistulas are important and potentially fatal complications. We aimed at determining the incidence, predictive factors, and management of recurrence of post-LSG fistulas. Methods: This is a retrospective cohort study of 12 consecutive patients with LSG fistulas managed endoscopically between 2008 and 2013. We analyzed factors associated with recurrence of post-LSG fistulas and the efficacy of a primarily endoscopic approach to manage fistula recurrence. Results: The average age at fistula detection after LSG was 43.3 ± 10.9 years, and 10 (83%) patients were female. The median interval between surgery and initial fistula detection was 14 (4–145) days. Fistulas were located at the gastric cardia in 9/12 patients. A median of 4 (1–10) endoscopies were performed per patient until all fistulas were successfully closed. The median follow-up was 30.5 (15–72) months. Fistula recurrence was detected in 3 (25%) female patients with an average age of 31.7 ± 7.9 years after a median of 119 (50–205) days of the initial fistula closure. Fistulas in all 3 patients recurred at the gastric cardia and were successfully managed endoscopically. There was a second recurrence in 1 patient after 6 months, and she was re-operated with anastomosis of a jejunal loop at the site of the fistula orifice at the gastric cardia. We did not find any factors at initial fistula detection that were significantly associated with fistula recurrence. There were no deaths related to initial fistula after LSG and fistula recurrence. Conclusions: A primarily endoscopic approach is an effective and safe method for the management of fistulas after LSG. Fistula recurrence occurred in 25% of patients and was managed endoscopically. Key Messages: Although we could not define predictive factors of post-LSG fistula recurrence, it is a clinical reality and can be managed endoscopically.

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“…[20] Some authors recommend upper gastrointestinal radiography and endoscopy instead of CT suggesting on the fact that obesity produces technical difficulties and low image quality. [21] Early postoperative leak tests with methylene blue and gastrografin are recommended by many authors although they are shown neither specific nor sensitive by restrospective reviews. [22,23] It is crucial to recognize the fact that a normal test cannot rule out a fistula and may cause delay in diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Complications in bariatric surgery

Bozkurt¹

2017

Laparosc Endosc Surg Sci

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Bariatric surgery is one of the fastest growing hospital procedures performed in the world and is also an important option for patients with extreme obesity and co-morbidities. Bariatric surgery, however, involves risks and complications. Complications following surgical treatment of severe obesity vary based upon the procedure performed, and rate can be as high as 40 percent. Due to high surgical volume, improving the safety of these operations has become a high priority, leading to development of strict criteria for center accreditation, guidelines for safe and effective bariatric surgery, and careful monitoring of surgical outcomes. This report is a review of major complications of bariatric surgery.

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Gastric leakage after sleeve gastrectomy—clinical presentation and therapeutic options

Cited by 86 publications

References 30 publications

Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors

Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors

Fistula Recurrence: A Clinical Reality after Successful Endoscopic Closure of Laparoscopic Sleeve Gastrectomy Fistulas

Complications in bariatric surgery

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