The Use of Intraoperative Endoscopy May Decrease Postoperative Stenosis in Laparoscopic Sleeve Gastrectomy

Nimeri, Abdelrahman; Maasher, Ahmed; Salim, Elnazeer; Ibrahim, Maha; Hadad, Mohammed Al

doi:10.1007/s11695-015-1958-2

Cited by 34 publications

(15 citation statements)

References 13 publications

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“…Presence of obstruction increases the risk of leakage post operatively. 9 While it is difficult to assess the presence of a stenosis at the incisura laparoscopically, this can easily be detected using intra operative endoscopy.…”

Section: Discussionmentioning

confidence: 99%

Sleeve Gastrectomy with Intra-operative Endoscopic Guidance

Hassan

Ghamrini

Elsayed

2019

Ain Shams Journal of Surgery

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To assess the advantage of using intraoperative endoscopic guidance during sleeve gastrectomy and its efficiency to decrease various complications.Methods: This was a retrospective study at Ain shams specialized hospital and Cure hospital. Patients who had sleeve gastrectomy with intra-operative endoscopic guidance were included in this study.Results: From September 2017 to February 2019, 226 patients had LSG as a definitive bariatric procedure. All the procedures were done with intra-operative endoscopic guidance. Seventy nine percent were female with a mean age of 39.7±14 years (range 23-49 years) and a mean body mass index of 48.6±14 kg/m2 (range 41-59 kg/m2 ). Two cases showed intraoperative leak that was managed intraoperatively by over suturing and omental patch. One case showed mild twisting at the incisura angularies that was managed intraoperatively by fixing the twisted angle to the retroperitoneum. Marked internal bleeding from the staple line was seen in two cases; which necessitated endoscopic clip insertion in one case and epinephrine injection for the other. The average length of the hospital stay was 1.8 days post operatively. The post-operative leakage was 0% and no cases had obstructive symptoms. Conclusion:Sleeve gastrectomy surgery with endoscopic guidance is very important not only to calibrate the size of the gastric pouch instead of the bougie, but also to prevent various complications as gastric obstruction or bleeding or even fatal complications as gastric leak.

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Section: Discussionmentioning

confidence: 99%

Sleeve Gastrectomy with Intra-operative Endoscopic Guidance

Hassan

Ghamrini

Elsayed

2019

Ain Shams Journal of Surgery

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“…Nimeri et al performed IOE during LSG and found 10 cases (3.2%) of gastric stenosis during the procedure. Stenosis resolved after removing over-sewing sutures and clinical stenosis after LSG was 0% [ 20 ]. As shown in the present study, IOE can guide the surgeons to check the cause and location of stenosis with revision performed laparoscopically.…”

Section: Discussionmentioning

confidence: 99%

The utility of intraoperative endoscopy to assist novice surgeons in the detection of gastric stenosis during laparoscopic sleeve gastrectomy

Chen

Tsai²,

Chen

et al. 2022

BMC Surg

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Background Laparoscopic sleeve gastrectomy (LSG) is a commonly performed bariatric surgery. Gastric stenosis and leaks are 2 major complications associated with LSG and revision surgery might be needed. Herein, we report our experience of intraoperative endoscopy (IOE) to evaluate stenosis and leaks during LSG. Methods LSG was performed by three surgeons. Patients who underwent LSG and IOE between January 2016 and March 2020 were enrolled and assigned to two groups: group 1 (1st–30th LSG case for each surgeon) and group 2 (> 30th LSG for each surgeon). Patients’ anthropometric and biochemical data pre- and post-LSG, as well as IOE findings and follow-up esophagogastroduodenoscopy records were reviewed. Results In total, 352 patients were enrolled including 90 patients in group 1 and 262 patients in group 2. Three out of 352 patients (0.9%) were found to have stenosis by IOE, which was related to tightly gastropexy stitch or reinforcement stitch, all of which were in group 1. Stenosis was resolved after removal of the stitch during LSG. The incidence of gastric stenosis detected by IOE was 3.3% (3/90) and 0% (0/262) in group 1 and group 2, respectively (P = 0.003). No leakage was found in this study and no patient developed clinical or endoscopic stenosis after LSG. Conclusions The existing evidence showed that IOE can help detect gastric stenosis during LSG, especially for novice surgeons, and the stenosis could be resolved during operation.

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“…In addition, they stated that suturing the staple line was also a disadvantage in terms of bleeding. 12 This may be related to the level of experience with the suturing technique. The bleeding rate of 0.55% in our study is still low compared with the literature.…”

Section: Discussionmentioning

confidence: 99%

Does Fixation of Gastric Sleeve Prevent Functional Stenosis in Sleeve Gastrectomy Patients?

Şen

Sekmen

Türkçapar³

et al. 2020

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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The aim of this study is to determine whether gastric sleeve fixation prevents functional stenosis (twist or kink) and to investigate its effects on symptoms such as nausea and vomiting after laparoscopic sleeve gastrectomy (LSG).Methods: A total of 717 patients who underwent primary LSG for morbid obesity and completed at least 1 year of follow-up between 2012 and 2019 were included in the study. All operations were performed by the same surgical team using the same technique. The patients were divided into 2 groups, that is, group 1: standard LSG and group 2: gastric sleeve fixation with LSG. These 2 groups were compared in terms of demographic characteristics, baseline body mass index, follow-up duration, bleeding, leaks, gastric stenosis, postoperative nausea, vomiting, and the need for antiemetics. In the follow-up period, patients with suspected gastric stenosis underwent endoscopy and upper gastrointestinal series.Results: LSG was performed in 717 patients (55.2% female) with a mean age of 37.8 ± 11.5 years and a median body mass index of 42.2 (30.2 to 74.2) kg/m 2 . The 241 patients in the first group underwent LSG without fixation, and the 476 patients in the second group with fixation. Functional stenosis was detected in 8 patients, all of whom were in group 1. One patient in group 1 had a leak on the background of functional stenosis. There was bleeding that required transfusion in 2 patients (group 1) and reoperation in 2 patients (group 2). None of the study patients died. During the in-hospital period, 122 (50.6%) patients in group 1 and 159 (33.4%) patients in group 2 had nausea and vomiting that required antiemetic treatment (P < 0.001). Conclusion:Gastric sleeve fixation in LSG prevents complications that may arise because of improper gastric mobilization. This method is effective in reducing nausea and vomiting in LSG patients.

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The Use of Intraoperative Endoscopy May Decrease Postoperative Stenosis in Laparoscopic Sleeve Gastrectomy

Abstract: Routine use of IOE in LSG has led to a change in the operative strategy and could be one of the reasons behind the acceptable leak and stenosis in this series of laparoscopic sleeve gastrectomy.

Cited by 34 publications

References 13 publications

Sleeve Gastrectomy with Intra-operative Endoscopic Guidance

Sleeve Gastrectomy with Intra-operative Endoscopic Guidance

The utility of intraoperative endoscopy to assist novice surgeons in the detection of gastric stenosis during laparoscopic sleeve gastrectomy

Does Fixation of Gastric Sleeve Prevent Functional Stenosis in Sleeve Gastrectomy Patients?

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