Gastric Leak Research Articles

Successful Management of Gastric Leakage Post Gastric Sleeve by Gastric Bypass Conversion

Gastric leak represents one of the most common, serious and challenging complications in bariatric procedures, and it is caused by both ischemic and mechanical failure. The management of these leaks remains controversial. In this clinical case, we describe the occurrence of a gastric leak after a gastric sleeve, which was successfully treated by gastric bypass using a laparoscopic technique.

S4500 Spontaneous Versus Secondary: A Challenging Case of Fungal Peritonitis in a Cirrhotic Patient Presenting With Gastric Perforation Complicated by Persistent Gastric Leak

S4500 Spontaneous Versus Secondary: A Challenging Case of Fungal Peritonitis in a Cirrhotic Patient Presenting With Gastric Perforation Complicated by Persistent Gastric Leak

Can We Predict Gastric Leaks After Laparoscopic Sleeve Gastrectomy by Evaluating the Complete Blood Count on Postoperative Day 1?

We assessed whether postoperative day-1 (POD-1) complete blood count (CBC) test parameters, including red cell distribution width (RDW), mean platelet volume (MPV), plateletcrit (PCT), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR), could identify patients with gastric leaks after laparoscopic sleeve gastrectomy (LSG). Patients with postoperative gastric leaks (n=36) and patients with no complications who were selected by age-sex-BMI matching (n=254) were included in the study. The levels of RDW, MPW, PCT, PLR, and NLR were compared between groups in univariate analyses. Receiver operating characteristic (ROC) curve analysis was run for CBC parameters with a P -value<0.05 in univariate analyses. The area under the curve (AUC) was evaluated, and a cutoff value was determined. Sensitivity, specificity, likelihood ratio (LR), positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. The level of PCT was significantly lower, while levels of PLR and NLR were significantly higher in patients with postoperative gastric leaks as compared with those without ( P <0.05). The AUC of both PCT and PLR was <0.750, while the AUC of NLR was 0.911. NLR cutoff at 3.6 yielded 80% sensitivity, 92% specificity, and an LR of 10. In the study cohort, PPV of 59%, NPV of 97%, and an accuracy of 90% were found. Our results suggest that NLR at POD-1, with a cutoff value of 3.6, is a useful indicator of postoperative gastric leak who underwent LSG. We recommend the use of this easily calculated parameter in clinical practice.

Bioresorbable, wireless, passive sensors for continuous pH measurements and early detection of gastric leakage.

Continuous monitoring of biomarkers at locations adjacent to targeted internal organs can provide actionable information about postoperative status beyond conventional diagnostic methods. As an example, changes in pH in the intra-abdominal space after gastric surgeries can serve as direct indicators of potentially life-threatening leakage events, in contrast to symptomatic reactions that may delay treatment. Here, we report a bioresorbable, wireless, passive sensor that addresses this clinical need, designed to locally monitor pH for early detection of gastric leakage. A pH-responsive hydrogel serves as a transducer that couples to a mechanically optimized inductor-capacitor circuit for wireless readout. This platform enables real-time monitoring of pH with fast response time (within 1 hour) over a clinically relevant period (up to 7 days) and timely detection of simulated gastric leaks in animal models. These concepts have broad potential applications for temporary sensing of relevant biomarkers during critical risk periods following diverse types of surgeries.

Outcomes of bariatric surgery in the setting of compensated advanced chronic liver disease associated with clinically significant portal hypertension: a multicenter, retrospective, cohort study on feasibility and safety.

The obesity epidemic has led to an increase in the proportion of patients with chronic liver disease due to metabolic associated steatosic liver disease and in the prevalence of obesity in patients with cirrhosis. Metabolic and bariatric surgery (MBS) has been proven to determine weight loss, obesity-related medical problems remission, and liver steatosis, inflammation, and fibrosis improvement. However, cirrhosis and portal hypertension are well-known risk factors for increased morbidity and mortality after surgery. The aim of this study is to evaluate the safety of MBS in patients with compensated advanced chronic liver disease (cALCD) and clinically significant portal hypertension (CSPH). This is an international, multicentric, retrospective study on 63 individuals affected by obesity with cALCD and CSPH who underwent MBS in tertiary referral centers with experts hepatobiliary surgeons between January 2010 and October 2022. The primary endpoint was postoperative mortality at 90 days. The secondary endpoints included postoperative weight loss at last follow-up and postoperative complication rate. In addition, the authors performed subgroup analyses of Child-Pugh (A vs. B) score, MELD (≤9 vs. >9) score, and type of surgery. One patient (1.6%) experienced gastric leakage and mortality. There were three (5%) reported cases of portal vein thrombosis, two (3%) postoperative acute renal failure, and one (1.6%) postoperative encephalopathy. Child-Pugh score A resulted to be a protective factor for intraoperative bleeding requiring transfusion at univariate analysis (OR: 0.73, 95% CI: 0.55-0.97, P =0.046) but not at multivariate analysis. MELD>9 score and the type of surgery did not result to be a risk factor for any postoperative complication. MBS is safe in patients with cALCD and CSPH performed in tertiary bariatric referral centers with hepatobiliary expert surgeons. Larger, prospective studies with longer follow-up periods are needed to confirm these results.

The Effects of Reinforcement Techniques in Sleeve Gastrectomy and Roux-en-Y Gastric Bypass: Protocol for a Web-Based Survey, Systematic Review, and Meta-Analysis.

The effects of reinforcement are still controversial in bariatric surgery, and variations may exist in using this technique. This protocol describes a study that aims to survey the views of bariatric surgeons on reinforcement techniques and evaluate the effects of applying reinforcement techniques in sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). This study is composed of 2 parts. Part 1 will investigate the differences of using reinforcement techniques among surgeons worldwide who perform SG or RYGB through a survey. The survey will be conducted by email and social media. Part 2 will evaluate the safety and effectiveness of using omentopexy or staple line reinforcement in SG and RYGB by systematic review and meta-analysis. In this part, literature searches will be performed in English databases, including CENTRAL, EMBASE CINAHL, Web of Science, and PubMed, and Chinese databases, including Wanfang, China National Knowledge Infrastructure, Database of Chinese Technical Periodicals, and Chinese Biological Medicine, from their establishment to November 2023. Randomized controlled trials and case-control studies will be included. The primary outcomes are rates of postoperative bleeding and gastric leakage. The secondary outcomes include anastomotic stenosis, surgical site infection, reoperation, estimated intraoperative blood loss, operative time (minutes), length of hospital stay (days), overall complications, and 30-day mortality. The meta-analysis will be conducted using RevMan 5.4 under the random-effects model, as well as through extensive subgroup and sensitivity analyses. P values <0.05 will be considered statistically significant. This study was registered with PROSPERO (Prospective Register of Systematic Reviews) in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols). The results of this study will be published in a peer-reviewed journal. The web-based survey and initial title or abstract review of papers identified by the search strategy will be completed in November 2023. The second round of title or abstract review and downloading of the papers for full-text inclusion will be completed in January 2024. We aim to complete data extraction and meta-analysis by February 2024 and expect to publish the findings by the end of March 2024. This study aims to investigate the impact of reinforcement techniques on reducing the incidence of postoperative complications in SG and RYGB procedures and provide assistance for standardizing the procedures of SG and RYGB operations for bariatric surgeons. PROSPERO CRD42022376438; https://tinyurl.com/2d53uf8n. PRR1-10.2196/50677.

IBC-Oxford University2023_BJSPoster_5In The Era of “Sleeve Revision”, What is The Perfect Algorithm?: Suggested Algorithm with Review of the literature

Abstract Background Laparoscopic sleeve gastrectomy (LSG) is the mainstream treatment option for patients with morbid obesity due to restrictive and endocrine mechanisms, however it requires modifications for a subset of patients because of weight regain and tough complications, such as gastroesophageal reflux, strictures, gastric leak, and persistent metabolic syndrome. Revision surgeries have become more and more indispensable in bariatric surgery, accounting for 7.4% in 2016. Methods A systematic literature search was performed in PubMed, Embase and Cochrane library. Data were collected and analysed. Results Revisional bariatric surgeries after LSG include Roux-en-Y gastric bypass, repeated sleeve gastrectomy, biliopancreatic diversion, duodenal switch, duodenal-jejunal bypass, one-anastomosis gastric bypass (MGB), single anastomosis duodeno-ileal bypass (SADI) and transit bipartition. The overall revision rate was 10.4%, but for patients with ≥ 10-year follow-up, the rate was 22.6%. European studies had a higher revision rate (14.4%) than other studies. The most common reason for revision was failure in weight loss, and the most frequent revisional procedure was gastric bypass. Conclusion Reaching a clear algorithm for revisional bariatric surgery is still debated. However, we assume that it depends mainly on pre-revisional BMI and presence of GERD symptoms as follows: patients with BMI&amp;gt; 40 kg/m2 should receive Standard R-Y gastric bypass, those with BMI &amp;lt; 40 kg/m2 with GERD should have R-Y gastric bypass with long biliopancreatic limb or MGB with RY configuration. Patients with BMI &amp;lt; 40 kg/m2 without GERD may benefit from MGB or SADI

Does Omentopexy Make a Difference in Laparoscopic Sleeve Gastrectomy for Obesity Treatment? A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis aimed to evaluate the comparative outcomes of laparoscopic sleeve gastrectomy with omentopexy (LSGO) versus conventional laparoscopic sleeve gastrectomy (LSG) for obesity treatment. A systematic online search was conducted using the available online databases, and Revman software was used for data analysis. Twenty-two eligible comparative studies were included (n = 9,321). LSGO showed a significantly lower rate of gastric leak (P = 0.0001), staple line bleeding (P = 0.00001), and gastric torsion (P = 0.002) in comparison to the LSG group. Operative time was significantly shorter in the LSG group (P = 0.00001); however, the length of hospital stay was in favour of the LSGO (P = 0.00001). Compared to LSG without omentopexy, LSG with omentopexy provides a significantly lower rate of postoperative complications and shorter LOS at the expense of operative time.

Endoscopic Administration of Combined Autologous Mesenchymal Stem Cells and Platelet-Rich Plasma for the Treatment of Gastric Staple Line Leaks After Sleeve Gastrectomy.

Gastric staple line leak treatment after laparoscopic sleeve gastrectomy (LSG) remains challenging. Regenerative medicine is gaining place in the accelerated treatment of damaged tissues. This study presents the first series of gastric leak treatment after LSG using endoscopic intragastric administration of combined autologous mesenchymal stem cells (MSC) and platelet-rich plasma (PRP). MSC-PRP harvesting and endoscopic administration techniques are described in detail. Data were prospectively gathered and analyzed. Primary endpoints were morbidity/mortality rates and fistula closure time. Twelve patients (9 women, 3 men) were included. Median age was 41.5years, median weight 105.5kg and median BMI 38.9kg/m2. Median time to gastric staple line leak detection was 10days post-LSG. Median time between re-laparoscopy and MSC-PRP administration was 5days. MSC-PRP endoscopic administration was successfully performed and tolerated by all patients, with median procedure duration of 27min and minimal blood loss. Four postoperative complications were noted: two patients with increased tibial pain at tibial puncture site, one with tibial hematoma, and one with epigastric pain/dysphagia. Median length of hospital stay was 1day. Gastric leak healing occurred after a median of 14days, only two patients requiring a second MSC-PRP endoscopic injection. Median follow-up was 19months, all patients being in good health at last contact. Endoscopic administration of combined autologous MSC-PRP seems to be a good option for treatment of gastric leaks after sleeve gastrectomy. It is a challenging procedure that should be performed in specialized bariatric centers by expert bariatric surgeons and endoscopists after meticulous patient selection.

Patient Outcomes and Rate of Intensive Care Unit Admissions Following Bariatric Surgery: A Retrospective Cohort Study of 775 Patients.

Background The last two decades have seen a significant rise in obesity and its adverse consequences across the globe. Bariatric surgery has emerged as a widely employed therapeutic approach for weight reduction and alleviating the risk of obesity-related chronic diseases such as diabetes, cardiovascular diseases, and cancer. As bariatric procedures are gaining popularity, the complications associated with these procedures can not be ignored. This retrospective study aimed to investigate the incidence of intensive care unit (ICU) admissions following bariatric surgery and ICU-related mortality. Methodology This retrospective study conducted at King Hamad University Hospital, Bahrain evaluated the patient outcomes and the rate of ICU admissions following bariatric surgery between 2018 and 2022. Demographic data of the patients were extracted from electronic health records. The primary endpoint was ICU admission incidence and mortality, while secondary outcomes included risk factors, duration of ICU stay, and complications leading to ICU admission. Results Of the 775 patients included, 66.3% were female. The mean age of the patients was 35.92 ± 21.12 years. Over 91% of the patients had a body mass index above 30 kg/m2. The most common primary procedure was laparoscopic sleeve gastrectomy (75%), followed by gastric bypass (22.6%). In revision bariatric surgery, the majority (91.3%) had a conversion from sleeve gastrectomy to gastric bypass. Overall, 0.77% of patients were admitted to the ICU, with the majority being unplanned ICU admissions (0.52%). The average ICU stay was 21 days (1 to 54 days). The most common reason for ICU admission was sepsis, septic shock, and gastric leakage. Conclusions The results of this study show a relatively lower number of ICU admissions after bariatric surgery compared to previous studies.

Efficacy analysis of laparoscopic sleeve gastrectomy in morbidly obese patients aged 10-21 years

Objective: To investigate the efficacy of laparoscopic sleeve gastrectomy (LSG) in morbidly obese patients aged 10 to 21 years. Methods: We conducted a retrospective analysis of clinical data from 89 out of 200 patients who underwent LSG at the Gastrointestinal Surgery/Weight Loss Center of the First Affiliated Hospital of Jinan University between January 2015 and December 2020. The primary outcome measures were the completion rate of LSG, the incidence of perioperative complications, and weight-related indicators 3, 6, 12, and ≥24 months postoperatively. Additionally, we compared glucose metabolism, lipid metabolism, vitamin levels, liver function, and other relevant biochemical variables before and after surgery. Normally distributed continuous data are presented as x±s. Because the numbers of patients at each follow-up time point were not identical with the number of patients in the study cohort preoperatively, independent sample t-tests were used for intergroup comparisons. Non-normally distributed continuous data are presented as M(Q1, Q3), and Mann-Whitney U tests were used for intergroup comparisons. Results: Among the 89 patients, 35 were male (39.3%), the mean age was (18±2) years, and mean body mass index (BMI) 38.5±4.8 kg/m²; 37 of the patients having a BMI greater than 40 kg/m². Additionally, 63 patients (70.8%) had fatty livers, 34 (38.2%) hyperuricemia, 31(34.8%) sleep apnea syndrome, 20 (22.4%) gastroesophageal reflux, eight (8.9%) type 2 diabetes, and two (2.2%) hypertension. All 89 patients underwent LSG surgery successfully, with no conversions to open surgery. During the perioperative period, there were no cases of major bleeding, gastric leakage, or infections. Notable postoperative symptoms included nausea, vomiting, and pain, most of which improved by the second postoperative day. BMI values 3, 6, and 12 months postoperatively had decreased to 31.5±5.8 kg/m², 28.6±4.3 kg/m², and 26.3±4.4 kg/m², respectively. All of these BMI values differed significantly from preoperative values (all P<0.05). At 12 and ≥24 months postoperatively, the percentages of total weight loss were (31.3±9.3)% and (33.1±10.5)%, respectively, both differing significantly from 3 months postoperatively (20.5±5.1)% (all P<0.05). The percentages of excess weight loss at 12 and ≥24 months postoperatively were 91% (70%, 113%) and 95% (74%, 118%) , respectively, both differing significantly from the percentage of total weight loss 3 months postoperatively (56% [45%, 72%]) (both P<0.05). Alanine transaminase and aspartate transaminase serum concentrations decreased from preoperative values of 44.4 (25.5, 100.5) U/L and 29.0 (9.5, 48.0) U/L to 14.0 (10.8, 18.3) U/L and 13.0 (10.5, 17.3) U/L, respectively, ≥24 months postoperatively. Hemoglobin A1c decreased from 5.6 (5.3, 5.8)% preoperatively to ≥24 months postoperatively 5.3 (5.0, 5.4)%. High-density lipoprotein increased from 1.0 (0.9, 1.2) mmol/L preoperatively to 1.4 (1.1, 1.6) mmol/L ≥24 months postoperatively. Vitamin B12 decreased from 350.0 (256.8, 441.3) μg/L preoperative to 230.3(195.4, 263.9) μg/L ≥24 months postoperatively. All differed significantly from preoperative values (all P<0.05). Conclusion: LSG has favorable efficacy in morbidly obese patients aged 10 to 21 years. However, further confirmation is required through long-term, multicenter, randomized, controlled trials.

Endoscopic stent placement for the management of gastro-pleural and gastro-cutaneous fistula post laparoscopic sleeve gastrectomy: a case report

BackgroundGastro-pleural and gastro-cutaneous fistulae formation are rare yet life-threatening complications post-bariatric surgery. To our knowledge so far only limited cases of gastro-pleural and gastro-cutaneous fistulae post gastric sleeve surgery have been reported in the literature with their corresponding management. Therefore, we are reporting a case of placement of an endoscopic stent in the management of gastro-cutaneous fistula post laparoscopic sleeve gastrectomy.Case presentationA 42 years old Pakistani, female morbidly obese patient, underwent laparoscopic sleeve gastrectomy. Within a week after the procedure, the patient presented with dyspnea. Workup showed a gastric leak for which percutaneous drain placement was done. Later, gastro-pleural and gastro-cutaneous fistulae were formed for which endoscopic fistula closure was done using a metallic stent.ConclusionEndoscopic stent placement is an emerging field and it is considered safe and effective for the management of complications related to bariatric surgery.

Outcome of gastric gastrointestinal stromal tumors at National Cancer Institute, Cairo University

Background The purpose of this research was to inspect the tumor landscapes, surgical particulars, and survival distribution of patients of gastric gastrointestinal stromal tumors (GIST) that were surgically removed at the National Cancer Institute, Cairo University. Materials and methods Patients who submitted an application to our clinic and were ultimately diagnosed with gastric GIST were included in this retrospective analysis. Patients’ ages and sexes were recorded, as well as their original tumor sites, histological features, staging, treatments received, treatment methods, and survival rates. Results There were a total of 23 patients, with a female to male ratio of 1 : 3, who had a diagnosis of gastric GIST. They averaged 56 years of age. Tumor sizes, on average was 11.2 cm. In 18 (78.3%) cases, the tumor was located at the distal end, whereas in 5 (21.7%) cases it was located at the proximal end. 19 patients underwent first surgery, whereas only 5 got neoadjuvant treatment focused on the primary tumor. 17 (73.9%) individuals (73.9%) had sleeve gastrectomy, making it the most prevalent operation. 7 days was the typical duration of stay in the hospital. Two patients showed postoperative gastric leakage; the first was treated conservatively, while the second was treated surgically and resulted in a total gastrectomy. With regard to risk categorization, 10 (43.5%) patients had tumors with a high level of risk, 9 (39.1%) had tumors with an intermediate risk, whereas just 4 (17.4%) had tumors with a low risk (Table 3). 16 (69.6%) patients received supplemental targeted treatment. The median duration of patient follow-up was 42.6 months, and all patients were tracked. The cumulative overall survival at 5 years was 82.1%, while the cumulative disease-free survival was 65.4%. Conclusion For individuals who need their gastric GIST removed, extensive local resection that preserves the stomach yields excellent functional and oncological results.

Endoscopic vacuum therapy as a first-line treatment option for gastric leaks after bariatric surgery: evidence from 10 years of experience.

Gastric (anastomotic or staple-line) leaks after bariatric surgery are rare but potentially life-threatening complications. Endoscopic vacuum therapy (EVT) has evolved as the most promising treatment strategy for leaks associated with upper gastrointestinal surgery. The aim of this study was to evaluate the efficiency of our gastric leak management protocol in all bariatric patients over a 10-year period. Special emphasis was placed on EVT treatment and its outcome as a primary treatment or as a secondary treatment when other approaches failed. This study was performed at a tertiary clinic and certified center of reference for bariatric surgery. In this retrospective single-center cohort study, clinical outcomes of all consecutive patients after bariatric surgery from 2012 to 2021 are reported, with special emphasis placed on gastric leak treatment. The primary endpoint was successful leak closure. Secondary endpoints were overall complications (Clavien-Dindo classification) and length of stay. A total of 1046 patients underwent primary or revisional bariatric surgery, of whom 10 (1.0%) developed a postoperative gastric leak. Additionally, 7 patients were transferred for leak management after external bariatric surgery. Of these, 9 patients underwent primary and 8 patients underwent secondary EVT after futile surgical or endoscopic leak management. The efficacy of EVT was 100%, and there were no deaths. Complications did not differ between primary EVT and secondary treatment of leaks. Length of treatment was 17 days for primary EVT versus 61 days for secondary EVT (P = .015). EVT for gastric leaks after bariatric surgery led to rapid source control with a 100% success rate both as primary and secondary treatment. Early detection and primary EVT shortened treatment time and length of stay. This study underlines the potential of EVT as a first-line treatment strategy for gastric leaks after bariatric surgery.

Long-term follow-up of a cohort with post sleeve gastrectomy leaks: results of endoscopic treatment and salvage surgery.

Laparoscopic sleeve gastrectomy (LSG) is the most performed bariatric procedure worldwide. The most challenging postoperative complication is gastric leak. The objectives of this study are to examine the efficacy and morbidity of different therapeutic strategies addressing leakage, and the long-term outcomes of a cohort of LSG leaks. A retrospective review of patients treated for LSG leaks between September 2014 and January 2023 at our high-volume bariatric surgery center was performed. The charts of 37 patients (29 women and 8 men) were reviewed, with a mean age of 43years and a median follow-up of 24months. The mean preoperative body mass index was 45.1kg/m2. Overall, 30/37 (81%) patients were successfully treated with endoscopic management, and 7/37 (19%) ultimately underwent salvage surgery. If the leak was diagnosed earlier than 6weeks, endoscopic treatment had a 97% success rate. The median number of endoscopic procedures was 2 per patient, and included internal pigtails, stents, septoplasty, endoluminal vacuum therapy and over-the-scope clips. Complications included stent-related ulcers (10), esophageal stenosis requiring endoscopic dilatations (4), stent migrations (2) and kinking requiring repositioning (1), and internal pigtail migration (3). Revisional surgery consisted of proximal gastrectomy and Roux-en-Y esophago-jejunal anastomosis, Roux-en-Y fistulo-jejunostomy or classic Roux-en-Y gastric bypass proximal to the gastric stricture. In 62% of the cases, the axis/caliber of the LSG was abnormal. Beyond 4 attempts, endoscopy was unsuccessful. The success rate of endoscopic management dropped to 25% when treatment was initiated more than 45days after the index surgery. Purely endoscopic management was successful in 81% of cases; with 97% success rate if diagnosis earlier than 6weeks. After four failed endoscopic procedures, a surgical approach should be considered. Delayed diagnosis appears to be a significant risk factor for failure of endoscopic treatment.

Safety of Concomitant Laparoscopic Cholecystectomy and Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients: A Meta-Analysis

Abstract Background Laparoscopic sleeve gastrectomy is one of the most common bariatric procedure performed. The prevalence of cholelithiasis in morbidly obese individuals is 19–30 % and Gall stones are more symptomatic in obese patients than in non-obese patients. This study evaluates the safety of performing laparoscopic sleeve gastrectomy and laparoscopic cholecystectomy in the same session. Objective To evaluate the safety profile of performing laparoscopic cholecystectomy and sleeve gastrectomyin the same session in terms of : The incidence of biliary leakage. The incidence of gastric leakage. The incidence of intra operative bleeding from the sleeve gastrectomy and the cholecystectomy. The incidence of post-operative bleeding. The incidence of post-operative surgical site infection. Operation time. Length of hospital stay. Method Selected papers for the present meta-analysis included those that provided data from January 2010 to December 2020 on factors related to the patients who undergone laparoscopic sleeve gastrectomy with and without laparoscopic cholecystectomy. When institutions have published duplicate trials, only the most updated reports were included for qualitative appraisal. All publications were limited to human subjects and English language. Abstracts, case reports, conference presentations, editorials and expert opinions were excluded. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2021. Data Extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures. Conclusion Overall concomitant laparoscopic sleeve gastrectomy and laparoscopic cholecystectomy appears to be a safe procedure. The increase in surgical site infection and pneumonia may warrant prophylaxis against such infections with antibiotics. Another study is needed to determine the need and efficacy of such prophylaxis

Management and outcomes of gastric leak after sleeve gastrectomy: results from the 2010-2020 national registry.

Management of gastric leak after sleeve gastrectomy (SG) is challenging due to its unpredictable outcomes. We aimed to summarize the characteristics of SG leaks and analyze interventions and corresponding outcomes in a real-world setting. To retrospectively review of 15,721 SG procedures from 2010 to 2020 based on a national registry. A cumulative sum analysis was used to identify a fitting curve of gastric leak rate. The Kaplan-Meier method and log-rank tests were performed to calculate and compare the probabilities of relevant outcomes. The logistic regression analysis was conducted to determine the predictors of acute leaks. A total of 78 cases of SG leaks were collected with an incidence of 0.5% (78/15,721) from this registry (6 patients who had the primary SG in non-participating centers). After accumulating 260 cases in a bariatric surgery center, the leak rate decreased to a stably low value of under 1.17%. The significant differences presented in sex, waist circumference, and the proportion of hypoproteinemia and type 2 diabetes at baseline between patients with SG leak and the whole registry population ( P = 0.005, = 0.026, <0.001, and = 0.001, respectively). Moreover, 83.1% (59/71) of the leakage was near the esophagogastric junction region. Leakage healed in 64 (88.9%, 64/72) patients. The median healing time of acute and non-acute leaks was 5.93 months and 8.12 months, respectively. Acute leak (38/72, 52.8%) was the predominant type with a cumulative reoperation rate >50%, whereas the cumulative healing probability in the patients who required surgical treatment was significantly lower than those requring non-surgical treatment ( P = 0.013). Precise dissection in the His angle area was independently associated with a lower acute leak rate, whereas preservation ≥2 cm distance from the His angle area was an independent risk factor. Male sex, elevated waist circumference, hypoproteinaemia, and type 2 diabetes are risk factors of gastric leaks after SG. Optimizing surgical techniques, including precise dissection of His angle area and preservation of smaller gastric fundus, should be suggested to prevent acute leaks.

Surgical Sealant with Integrated Shape-Morphing Dual Modality Ultrasound and Computed Tomography Sensors for Gastric Leak Detection.

Postoperative anastomotic leaks are the most feared complications after gastric surgery. For diagnostics clinicians mostly rely on clinical symptoms such as fever and tachycardia, often developing as a result of an already fully developed, i.e., symptomatic, surgical leak. A gastric fluid responsive, dual modality, electronic-free, leak sensor system integrable into surgical adhesive suture support materials is introduced. Leak sensors contain high atomic number carbonates embedded in a polyacrylamide matrix, that upon exposure to gastric fluid convert into gaseous carbon dioxide (CO2 ). CO2 bubbles remain entrapped in the hydrogel matrix, leading to a distinctly increased echogenic contrast detectable by a low-cost and portable ultrasound transducer, while the dissolution of the carbonate species and the resulting diffusion of the cation produces a markedly reduced contrast in computed tomography imaging. The sensing elements can be patterned into a variety of characteristic shapes and can be combined with nonreactive tantalum oxide reference elements, allowing the design of shape-morphing sensing elements visible to the naked eye as well as artificial intelligence-assisted automated detection. In summary, shape-morphing dual modality sensors for the early and robust detection of postoperative complications at deep tissue sites, opening new routes for postoperative patient surveillance using existing hospital infrastructure is reported.

Comment on: Laparoscopic Roux-en-Y fistulojejunostomy as a salvage procedure in patients with chronic gastric leak after sleeve gastrectomy

Comment on: Laparoscopic Roux-en-Y fistulojejunostomy as a salvage procedure in patients with chronic gastric leak after sleeve gastrectomy

Laparoscopic Roux-en-Y fistulojejunostomy as a salvage procedure in patients with chronic gastric leak after sleeve gastrectomy.

The most common postoperative complication of laparoscopic sleeve gastrectomy (LSG) is staple-line leak. Even if its rate following LSG has been recently reduced, management of chronic leaks remains challenging. To present a series of patients treated with laparoscopic Roux-en-Y fistulojejunostomy (LRYFJ) for chronic gastric leak (>12 wk) post-LSG. University hospitals; specialized bariatric surgery units. Data were prospectively gathered and retrospectively analyzed. Parameters of interest were patient characteristics, perioperative data, and postoperative outcomes. Hemodynamically unstable patients and/or presentations of signs of severe sepsis were excluded. Surgical technique was standardized. Fourteen patients underwent LRYFJ for chronic gastric leak (12 women, 2 men). The mean age was 49.2 years and the mean weight was 88.7 kg with a mean body mass index of 31.1 kg/m2. All procedures were successfully performed by laparoscopy except 1 (7.1%) converted to open surgery. The mean operative time was 198 minutes, with a mean estimated blood loss of 135.7 mL and 2 patients necessitating transfusion (14.2%). Mortality was null. Five postoperative complications were noted (35.7%): 2 leaks of the fistulojejunostomy treated by antibiotherapy and endoscopic drainage; 1 perianastomotic hematoma treated by relaparoscopy and antibiotherapy; and 1 pleural effusion and 1 hematemesis both medically treated. The mean length of hospital stay was 14 days. The mean follow-up was 40 months, with all patients being in good health at last contact. LRYFJ seems to be a good salvage option in selected patients for the treatment of chronic gastric leaks after LSG. However, it is a challenging procedure and should be performed in experienced bariatric centers by expert bariatric surgeons.