Complication Of Sleeve Gastrectomy Research Articles

Gastro-bronchial fistula major complication of sleeve gastrectomy

Abstract Background Gastro-bronchial fistula is a rare complication in gastroesophageal surgical procedures. It is difficult to diagnose and its management is complex. Non-surgical alternatives have been developed to eliminate the mortality of small fistulas. Endoscopic treatment is an option for patients with small fistulas or in a serious condition. Clinical case A 38 year-old woman with evidence of a gastro-bronchial fistula after gastric sleeve surgery, which was diagnosed during the post-operative period due to presenting with a various clinical symptoms. It was initially managed as a respiratory infection. When the trajectory of the fistula was established, an attempt was made to close with endoclips. However, there was also a haemo-pneumothorax, which required inserting drainage tubes and a thoracotomy. Endoscopic management was chosen with polytetrafluoroethylene oesophageal prosthesis and fibrin as a last therapeutic option as the patient had systemic inflammatory response syndrome. The outcome was favourable. Discussion Bariatric surgery has shown satisfactory results; however the complexity of the procedure can lead to severe complications, such as the present case. Gastro-bronchial fistulas represent a diagnostic and therapeutic challenge, requiring treatments from conservative management to endoscopic procedures, as in our patient. Conclusion Although gastro-bronchial fistulas are a rare complication, the use of endoscopy in their resolution should be considered as the method of choice, as it offers a lower morbidity in the patient that usually presents a difficult to control respiratory problem, and with satisfactory results in the medium and long term.

Endoscopic Closure of a Multifocal Leak From a Gastric Sleeve

Case Report: A 41-year-old male with gastric sleeve procedure 6 months prior presented with abdominal abscesses. Upper endoscopy showed fistulous tracts: site 2 and site 3. Site 2 fistula took a 180° turn traveling retrograde to gastroesophageal junction (GEJ). Argon plasma coagulation was applied to both tracts, followed by 10 cc of Tisseel, a fibrin sealant. Repeat endoscopic fistulogram revealed a persistent leak. Cautery was applied to site 2 with 5 cc Tisseel. Glue was seen extruding from site 3 confirming communication. Repeat EGD showed a new fistula, site 1, at GEJ and closed site 3 fistula. Two cc Tisseel was injected and it extruded from site 2. Follow-up EGD showed a smaller site 1 tract and repeat cautery, and Tisseel injection was applied. The patient continues to undergo endoscopic surveillance and management of the fistulae. Discussion: This is a case of common, but one of the most challenging, complications of sleeve gastrectomy, responsible for approximately 50% of deaths. Gastric leaks are affected by high intragastric pressure. Minimally invasive endoscopic techniques, use of glue or stent placement, are effective. This case was interesting due to its multifocal nature of communication between the fistulae. Through continued effective endoscopic maneuvers, we demonstrated adequate closure of a multifocal leak from a gastric sleeve.Figure 1: Fistula tract.Figure 2: Fluoro picture demonstrates communicating Fistula 2 and Fistula 3.Figure 3: APC ablation.

‘Stent in a Stent’—An Alternative Technique for Removing Partially Covered Stents Following Sleeve Gastrectomy Complications

Endoscopic stenting is a relatively new technique for the treatment of post sleeve gastrectomy complications. Partially covered stents are used in this method to minimise the risk of migration but they are associated with difficulties with removal. Patients requiring emergency stenting following sleeve gastrectomy underwent insertion of a partially covered metallic stent. One month later, if the stent was not easily removable, a fully covered overlapping stent was inserted and the patient was readmitted 2 weeks later for removal of both stents. Four patients required stenting following sleeve gastrectomy leaks, and one patient required stenting for a stricture. In these cases, a 'stent in a stent' technique was used for removal. This technique allows the safe removal of partially covered stents inserted following sleeve gastrectomy complications.

The early use of Roux limb as surgical treatment for proximal postsleeve gastrectomy leaks

BackgroundLaparoscopic sleeve gastrectomy (LSG) is thought to be a simpler and safer operation compared with malabsorptive operations that include an enteric anastomosis. Leakage along the staple line at the gastroesophageal junction (GEJ) is difficult to treat and is a known complication of sleeve gastrectomy. Nonsurgical treatment methods often fail to heal the leaks and patients often require conversion to other procedures for definitive treatment. We report our experience with conversion to Roux-en-Y anastomosis over the leak site as a treatment option, comparing patients who had early treatment to late intervention. The purpose of the study is to stress the medical and social benefits of early surgical reintervention with conversion to Roux-en-Y anastomosis over the leak site. MethodsSix patients underwent Roux limb placement over the leak site. Four of the patients had delayed surgery (group A), and the other 2 had early intervention (group B). ResultsPatients in group A had a median increase of all medical cost by 500%, whereas the 2 patients who underwent early intervention (group B) had an increase by 200%. The mean time until complete recovery (removal of all drains, adequate oral intake, and return to normal daily activity) in group A was 131.25 days (range 99–165) versus 38 days (range 28–48) in group B. ConclusionsRoux-en-Y gastrojejunostomy over the leak site is an effective technique to treat refractory staple line leakage and can be adopted as early treatment in selected patients after stabilization, thereby reducing the cost and length of hospital stays.

Gastrobronchial fistula as a late complication of sleeve gastrectomy

Sleeve gastrectomy is currently one of the most popular operations for morbid obesity. However, staple line leaks occur in up to 4.3% of cases, depending on the experience of the center, and can lead to major morbidity [1,2]. Abdominal sepsis, abscesses, fistulas, and respiratory failure are some of the most common complications of a leak. Most of these complications occur soon after the appearance of a leak. However, a gastrobronchial fistula usually occurs late after the procedure. We report 2 cases in which gastrobronchial fistulas developed several months after sleeve gastrectomy.

Successful Management of a Gastric Sleeve Leak with an Endoscopic Stent

Laparoscopic sleeve gastrectomy has been a recently developed technique for treating morbid obesity. Gagner and Patterson performed the first laparoscopic sleeve gastrectomy as part of a duodenal switch procedure at Mount Sinai Hospital in New York in 1999. Since then many surgeons and institutions have adopted this technique. One of the most dreaded complications of sleeve gastrectomy is a leak along the staple line. We present the case of a 23-year-old female with gastric sleeve leak managed successfully with a fully covered wall flex stent. Our aim is to examine the incidence, causes, classification, and presentation of gastric sleeve leaks and to evaluate the use of endoscopic stents in its management.

Splenic rupture as complication of sleeve gastrectomy

Splenic rupture as complication of sleeve gastrectomy

Complications of Sleeve Gastrectomy

Complications of Sleeve Gastrectomy

Splenic infarct as complication of sleeve gastrectomy

Sleeve gastrectomy is a restrictive procedure for the treatment of super morbid obesity that is rapidly gaining interest [1]. The operation was first described in 1988 as the initial restrictive component of the duodenal switch procedure [2]. More recently, surgeons began performing laparoscopic sleeve gastrectomy (LSG) as the first step in a 2-stage procedure for high-risk or super-obese patients, with the second step performed 6–12 months later and consisting of either duodenal switch or gastric bypass [3,4].