Postoperative Bleeding and Leakage After Sleeve Gastrectomy: a Single-Center Experience

Khoursheed, Mousa; Al-Bader, Ibtisam; Mouzannar, Ali; Ashraf, Aqeel; Bahzad, Yousef; Al-Haddad, Abdulla; Sayed, Ali El; Fingerhut, Abe

doi:10.1007/s11695-016-2215-z

Cited by 24 publications

(15 citation statements)

References 49 publications

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“…[7] The overall complication rate in large medical centers is <15%. [8] Khoursheed et al [9] reported their overall complication rate was 7.5%. The most serious complications after sleeve gastrectomy are bleeding and leak.…”

Section: Discussionmentioning

confidence: 96%

“…Some patients may require blood transfusion and/ or re-exploration. [9] Khoursheed et al [9] reported reopera- tion rate as 0.5% due to bleeding. In this study, one case was reoperated due to bleeding in the 6th hour postoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…Postoperative staple line leak was reported to occur in 0-6.7% of patients in systematic reviews. [9] Catheter was inserted surgically in 4 patients who developed leak. In 3 of these cases, leaks were closed after conservative followup and a case required endoscopic stenting.…”

Section: Discussionmentioning

confidence: 99%

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Indications of Reoperation After Sleeve Gastrectomy

Dogan¹

2019

Laparosc Endosc Surg Sci

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Introduction: Morbid obesity is a serious health condition. Surgical interventions play an essential role in treatment, and sleeve gastrectomy is one of the most widely performed bariatric surgical procedures. After bariatric surgery, some patients may require reoperation for several reasons, such as complications, cholelithiasis, and gastroesophageal reflux. This study is an examination of the indications for reoperation and the results observed in patients who underwent reoperation following sleeve gastrectomy. Materials and Methods: Patients who were reoperated on after sleeve gastrectomy for various reasons were analyzed retrospectively. The demographic characteristics, reoperation indications, surgical procedures, and results were analyzed. Results: Of a total of 1268 patients who underwent sleeve gastrectomy due to obesity, 15 who had a reoperation after laparoscopic sleeve gastrectomy were included in the study. The overall reoperation rate after sleeve gastrectomy was 1.18%. Cholelithiasis leak, hemorrhage, stenosis, intra-abdominal hematoma, and incisional hernia were identified as indications for reoperation. Conclusion: Reoperation for the patients who undergo bariatric surgery may be required for a number of reasons. The results of this study indicate that a second procedure after sleeve gastrectomy can be performed safely and with minimal risk.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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Indications of Reoperation After Sleeve Gastrectomy

Dogan¹

2019

Laparosc Endosc Surg Sci

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“…Early bleeding usually presents within the first 48 h in 1%-5% of patients after RYGB[6]. SG presents a variable rate of bleeding between 0% and 8%[7] whereas LAGB is almost never complicated with bleeding (0.1%)[8]. The risk of iatrogenic perforations at the surgical site along with the self-limited character in most cases are the reasons why minor bleeding is usually managed conservatively with fluid resuscitation or blood transfusion and proton pump inhibitors.…”

Section: Gastrointestinal Bleedingmentioning

confidence: 99%

Endoluminal solutions to bariatric surgery complications: A review with a focus on technical aspects and results

Souto-Rodríguez¹,

Alvarez-Sánchez²

2017

WJGE

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Obesity is a growing problem in developed countries, and surgery is the most effective treatment in terms of weight loss and improving medical comorbidity in a high proportion of obese patients. Despite the advances in surgical techniques, some patients still develop acute and late postoperative complications, and an endoscopic evaluation is often required for diagnosis. Moreover, the high morbidity related to surgical reintervention, the important enhancement of endoscopic procedures and technological innovations introduced in endoscopic equipment have made the endoscopic approach a minimally-invasive alternative to surgery, and, in many cases, a suitable first-line treatment of bariatric surgery complications. There is now evidence in the literature supporting endoscopic management for some of these complications, such as gastrointestinal bleeding, stomal and marginal ulcers, stomal stenosis, leaks and fistulas or pancreatobiliary disorders. However, endoscopic treatment in this setting is not standardized, and there is no consensus on its optimal timing. In this article, we aim to analyze the secondary complications of the most expanded techniques of bariatric surgery with special emphasis on those where more solid evidence exists in favor of the endoscopic treatment. Based on a thorough review of the literature, we evaluated the performance and safety of different endoscopic options for every type of complication, highlighting the most recent innovations and including comparative data with surgical alternatives whenever feasible.

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“…All patients who had bleeding (as defined before) required blood transfusion; however, major bleeding that required reoperation was seen in three patients who presented not only with drops of hemoglobin and tachycardia but they were in a state of shock, and they required urgent resuscitation and reoperation laparoscopically. All patients presented with postoperative bleeding and none was intraoperative [1].…”

mentioning

confidence: 99%

Postoperative Bleeding and Leakage After Sleeve Gastrectomy: a Single-Center Experience

et al. 2016

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Postoperative bleeding was defined as a drop of hemoglobin of more than 2 g associated with pallor, tachycardia, and abdominal pain and distension. Intra-abdominal fluid collections were sought by abdominal CT scan.All patients who had bleeding (as defined before) required blood transfusion; however, major bleeding that required reoperation was seen in three patients who presented not only with drops of hemoglobin and tachycardia but they were in a state of shock, and they required urgent resuscitation and reoperation laparoscopically. All patients presented with postoperative bleeding and none was intraoperative [1].Our rate of postoperative bleeding was within the range of what has been reported in the literature, and we did not encounter intraoperative bleeding.We avoid using clips or electrocoagulation since we think they are unsafe and may contribute to increase risk of postoperative leak. Instead, we suture the staple line, which is cheap too and we inspect it carefully. If we notice any further bleeding, we reinforce the site of bleeding with figure of eight stitch rather than using clips or electrocoagulation. With this technique that we have adopted lately, we have noticed further reduction in our postoperative bleeding rate.We had no leaks in our series and regional ischemia, and leak following oversewing was shown in animal studies and was not supported by clinical studies.

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Postoperative Bleeding and Leakage After Sleeve Gastrectomy: a Single-Center Experience

Cited by 24 publications

References 49 publications

Indications of Reoperation After Sleeve Gastrectomy

Indications of Reoperation After Sleeve Gastrectomy

Endoluminal solutions to bariatric surgery complications: A review with a focus on technical aspects and results

Postoperative Bleeding and Leakage After Sleeve Gastrectomy: a Single-Center Experience

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