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.
Highlights
The number of surgeries and metabolic interventions for patients with obesity have increased worldwide [1,2]
All patients treated in the time between February 2018 and March 2021 using endoscopic pressure therapy (ENPT) for staple line leaks (SLL) after laparoscopic sleeve gastrectomy (LSG) were considered for inclusion in this study, given the following criteria were fulfilled: confirmed diagnosis of SLL and treatment for the complication at our department
Twelve patients with SLL following LGS were included in this trial
Summary
The number of surgeries and metabolic interventions for patients with obesity have increased worldwide [1,2]. The most common surgery is the laparoscopic sleeve gastrectomy (LSG) to minimize the volume of the stomach and reduce food intake [5,6]. This surgical intervention is easy to implement, as it does not contain any anastomose. Surgical complications after sleeve gastrectomy remain challenging, especially the management of staple line leaks (SLL), which occur in up to 2% of LSG patients [7]. Due to the extensive visceral fat mass, the infection is initially captured and does not spread diffusely.
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