Role of Rendezvous-Procedure in the Treatment of Complications after Laparoscopic Sleeve Gastrectomy

Abstract

Introduction: Laparoscopic sleeve gastrectomy is one of the most commonly performed bariatric procedures worldwide with good results, high patient acceptance, and low complication rates. The most relevant perioperative complication is the staple line leak. For the treatment of this complication, endoscopic negative pressure therapy has proven particularly effective. The correct time to start endoscopic negative pressure therapy has not been the subject of studies to date. Methods: Twelve patients were included in this retrospective data analysis over three years. Endoscopic negative pressure therapy was carried out using innovative open pore suction devices. Patients were treated with simultaneous surgery and endoscopy, so called rendezvous-procedure (Group A) or solely endoscopically, or in sequence surgically and endoscopically (Group B). Therapy data of the procedures and outcome measures, including duration of therapy, therapy success, and change of treatment strategy, were collected and analysed. Results: In each group, six patients were treated (mean age 52.96 years, 4 males, 8 females). Poor initial clinical situation, time span of endoscopic negative pressure therapy (Group A 31 days vs. Group B 18 days), and mean length of hospital stay (Group A 39.5 days vs. Group B 20.17 days) were higher in patients with rendezvous procedures. One patient in Group B died during the observation time. Discussion: Rendezvous procedures for patients with staple line leaks after sleeve gastrectomy is indicated for serious ill patients with perigastric abscesses and in need of laparoscopic lavage. The one-stage complication management with the rendezvous procedure seems not to result in an obvious advantage in the further outcome in patients with staple line leaks after laparoscopic sleeve gastrectomy.

Compression pre-stapler firing and post-ignition wait during sleeve gastrectomy: a prospective randomized trial

“…Studies have shown that the use of reinforcing products on the stapling line is beneficial. 7 Stapler manufacturers suggest that tissue can be clamped between the jaws of the stapler and cut in a flat position. However, there are no recommendations regarding waiting time.…”

Risk Factors and Management Approaches for Staple Line Leaks Following Sleeve Gastrectomy: A Single-Center Retrospective Study of 402 Patients

“…In the event of failure of effective management with any of the aforementioned methods, surgical management should be the next logical step, since the time interval will likely be such, that the leak will now be considered chronic [ 61 ]. Revision options include fistulojejunostomy, RYGB conversion, and total or near total gastrectomy, or the described rendezvous procedure, a technically challenging undertaking that has yet to prove palpable advantages [ 62 , 63 , 64 , 65 ].…”

Increase in bile acids after sleeve gastrectomy improves metabolism by activating GPBAR1 to increase cAMP in mice with nonalcoholic fatty liver disease

“…5 Laparoscopic sleeve gastrectomy (LSG) is a surgical technique for weight loss, which can lead to marked weight loss with trifling complications, and there is no report of NAFLD aggravation after LSG. 6 Our study aims to explore ways to improve the metabolism in NAFLD after LSG.…”

“…Obesity is one of the independent risk factors for NAFLD and bariatric surgery is considered to be an effective method for losing weight in morbid obesity 5 . Laparoscopic sleeve gastrectomy (LSG) is a surgical technique for weight loss, which can lead to marked weight loss with trifling complications, and there is no report of NAFLD aggravation after LSG 6 . Our study aims to explore ways to improve the metabolism in NAFLD after LSG.…”