Post Laparoscopic Sleeve Gastrectomy Research Articles

The Effectiveness of Gastrografin Study and Multidetector CT Study in Evaluation of Early Complications of Laparoscopic Sleeve Gastrectomy Complications

Abstract Background: Laparoscopic sleeve gastrectomy is a rela-tively recent surgical technique that was estimated to account for about 5% of all bariatric surgery. Post-operative compli-cations detection could be done by either fluoroscopic gastro-grafin meal or multislice CT study before and after contrast administration. Aim of Study: To compare between the effectiveness of the main imaging modalities of early post-operative compli-cations of laparoscopic gastric sleeve surgery, including fluoroscopic gastrografin meal and multislice CT study. Patients and Methods: The study included 150 patients; 128 females (85%), and 21 males (15%). Their ages ranged from 26 to 55 years with mean age about 41 years. Patients were selected based on clinical suspicion of post-operative complications. Fluoroscopic gastrographin study and multi-detector CT study have been done. Operative findings corre-lation and clinical follow-up were the standard of reference. Results: Forty (30%) patients had matched fluoroscopic and CT findings, 110 (70%) patients had positive CT findings but, negative fluoroscopic findings. 0% had positive fluoro-scopic findings and negative CT findings. The leak was suspected in 80 patients, 5 patients with active bleeding that was clinically suspected, but the exact site of bleeding could not be identified by CT, 37 patients had serous fluid collection, splenic infarction was noticed in 5 patients, 3 patients developed post-operative hematoma one of them become infected, anterior abdominal wall hematoma seen in 5 patients, one patient developed portal vein thrombosis. Conclusion: Multidetector CT is better imaging modality in precise detection of early post laparoscopic sleeve gastrec-tomy complications than fluoroscopic gastrografin imaging.

Gastrobronchial fistula post laparoscopic sleeve gastrectomy in immunocompromised patient

Bariatric surgery is evolving worldwide nowadays. Postoperative complications are mainly represented by gastric leak reported range between 1% to 3.3%. The worse scenario of the leak post laparoscopic sleeve gastrectomy is a fistula. Many types of fistula were prescribed and one of the theses is gastrobronchial one. It has a catastrophic sequela if not diagnosed and treated efficiently early. It is difficult to manage either radiologically, endoscopically or surgically. No clear consensus yet for the standard of treatment for such complication especially if these patients are immunocompromised was the mortality will be very high. Therefore, we aim to contribute our successful approach to treating our patient. We report a case of a 27-year-old female who is obese with systemic lupus erythematous controlled medically underwent laparoscopic sleeve gastrectomy. 6 months later she presented to the hospital with productive cough post-operative stenting and esophageal dilation was performed. 15 months post LSG patient presented with productive cough with green sputum, food particle, and left-sided chest pain. Endoscopic clip placement was attempted with no avail. The management of gastrobronchial fistulas involves a comprehensive clinical evaluation. In the absence of red flags, initial conservative management should be undertaken. When all else fail, surgery is the only route towards a permanent and definitive treatment. The need for further research and consensus is of utmost importance to guide future surgeons and to increase awareness among the medical community, due to its presentation under the facade of common symptoms.

Management of leak after sleeve gastrectomy: outcomes of 73 cases, treatment algorithm and predictors of resolution.

IntroductionGastric leak post laparoscopic sleeve gastrectomy (LSG) is a severe complication that has been reported in 1.5–3% of cases. Management algorithms of leak exist; however, no known factors predict the time to resolution. This study aims to share outcomes of our management algorithm of post LSG leak, including the rate of resolution, complications, admission to the intensive care unit, conversion to other techniques, and mortality. To determine if any factors can predict the resolution time.MethodsA retrospective analysis of patients who had LSG leaks and was managed in the main tertiary center in Qatar (January 2012–December 2017).ResultsA total of seventy-three patients had post LSG leaks. Fifty-six (76.7%) underwent LSG outside our center. Thirteen leaks (17.8%) were after revisional LSG. Laparoscopic exploration was performed in twenty patients (27.4%) and feeding jejunostomy in nine patients (12.3%). Patients were followed up for 12 months. All healed within 8.8 ± 0.72 weeks. The resolution rate was (97.1%) without surgical conversion, while two patients required fistulo-jejunostomy. No patient died. Complications occurred; re-leak (14.9%) and splenic abscess (2.9%). Patients on jejunal feeding had shorter resolution time (HR = 2.7, P = 0.018), while patients on total parenteral nutrition and post-endoscopic dilatation had 66% and 50% increases in the resolution time; (HR = 0.34, P = 0.026) and (HR = 0.5, P = 0.047), respectively.ConclusionManagement of post-LSG leak is multimodal. Our clinical experience demonstrated less urge to perform extensive surgical interventions. Patients on enteral feeding had shorter resolution time while patients with sleeve stricture had a longer time to resolution.

Acute mesenteric venous thrombosis after laparoscopic sleeve gastrectomy: a case report and a literature review

Over the last decade, laparoscopic sleeve gastrectomy has become an increasingly popular surgical procedure for morbid obesity. Moreover, post-laparoscopic sleeve gastrectomy mesenteric venous thrombosis is very rarely reported. The presentation varies from mild non-specific abdominal symptoms to life threatening surgical emergency. Superior mesenteric vein thrombosis after bariatric surgery is a difficult diagnosis that needs a high index of suspicion. We report a case of thrombosis of the superior mesenteric vein, who presented as acute emergency to emergency room, shortly after sleeve gastrectomy. Patient underwent laparotomy and offered a resection of 60 cm of infarcted proximal jejunum with restoration of bowel continuity later. Patient subsequently recovered and followed several times in our outpatient and was free of symptoms.

A585 Iron and Related Nutritional Deficiencies Among Asians 1 Year Post Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy (LSG) is an effective treatment for obesity. Pre and post bariatric surgery nutrient deficiencies exist commonly. Literature on this is scant in Asian populations. Our study aims to identify predictors for baseline anemia in an Asian bariatric population and compare anemia and related nutrient deficiencies at baseline and 1-year post LSG.

Laparoscopic Sleeve Gastrectomy on the Horizon as a Promising Treatment Modality for NAFLD.

Nonalcoholic fatty liver disease (NAFLD) is viewed as the hepatic manifestation of the metabolic syndrome with hepatic fatty infiltration is the common liver pathology. NAFLD can lead to nonalcoholic steatohepatitis (NASH), liver cirrhosis, liver cell failure, and liver malignancy.The present work aims to prospectively study the histological changes that occur in NAFLD obese patients 1-year post-laparoscopic sleeve gastrectomy (LSG) based on standardized NAS (NAFLD activity score). This prospective study included 94 obese patients who underwent laparoscopic sleeve gastrectomy. Intraoperative wedge liver biopsy was taken from all patients with a follow-up liver biopsy at 12months after the operation. LSG produced a marked reduction in body weight with a mean reduction in BMI from 44.54 + 5.45 to 34.23 + 2.66kg/m2 at 12months. There were statistically highly significant improvements regarding metabolic comorbidities, blood pressure, lipid profile, and HbA1C at 12-month post-LSG (P < 0.001). The current study showed a highly statistically significant improvement at 1-year post LSG regarding steatosis grade, hepatocyte ballooning, lobular inflammation as well as fibrosis stage (P < 0.001). Moreover, the present study showed that NAS score significantly decreased from 5.20 + 1.96 at baseline to 2.63 + 1.55 at 1-year follow-up (P < 0.001). Our relatively large patient cohort shows a significant improvement of steatosis, steatohepatitis, and fibrosis at a 1-year follow-up. LSG can lead to resolution of NAFLD, and it may be in the near future another routine indication for bariatric surgery.

Post-operative CT imaging of laparoscopic sleeve gastrectomy: our initial experience

Background: Laparoscopic sleeve gastrectomy (LSG) is a restrictive type of bariatric surgery. It is safe and effective with its many advantages like relative simplicity of the procedure, lack of malabsorption component and anastomoses and retaining the anatomical gastrointestinal continuity. Obesity, a chronic disease, with the significant rise of its comorbidities and mortality is attributing to the major financial and health burden globally. Methods: We conducted a prospective study of over 43 patients (male 32, female 11) over 5 years period i.e., from 2012 to 2017. These patients were assessed with contrast enhanced computerized tomography (CECT) for detection of post-operative complications.Results: The patients with the body mass index (BMI) &gt;40 kg/m2 and or with a BMI &gt;35 and &lt;40 kg/m2 but with significant weight related comorbidities underwent Laparoscopic sleeve gastrectomy. Both intravenous (IV) and oral contrasts are used accordingly. With increasing number of surgeries and with associated co-morbidities complications following LSG are increasing, necessitating the need for a good understanding of clinical symptoms and post-operative complications of LSG. Post-operative imaging plays a crucial role in the early detection of complications resulting in reduced mortality rate.Conclusions: We suggest multidetector computed tomography (CT) with oral and IV contrast as an excellent tool for the patients having a nonspecific abdominal symptom post LSG.

The impact of preoperative body mass index on early complications post laparoscopic sleeve gastrectomy for morbid obesity

Abstract.Laproscopic sleeve gastrectomy is one of the most popular bariatric surgery for morbid obesity although it is associated with some complications ,this study aims to evaluate the impact of preoperative body mass index on early complications after laparoscopic sleeve gastrectomy for morbid obesity. Methods. This study included 15 patient who underwent laparoscopic sleeve gastrectomy in gastrointestinal and laparoscopic unit in zagazig hospital between march 2018 and February 2019.3 males and 12 females .patients were divided in two groups according to their BMI (group 1 50kg/m2).mean preoperative BMI was 51.17 kg /m2,mean age was 33 years, mean operatve time was 150 minutes.mean duration of hospital stay was 1.8 days, operative data and complications ,length of hospital stay and complications after discharge were recorded and evaluated.Results: When comparing between group with BMI >50 and group with BMI 50kg/m2 and below 50kg/m2 respectively . Complications during surgery and overall complications in ward and after discharge significantly were associated with BMI >50kg/m2. and longer in operation time and also longer in hospital stay, In this study, the mean operative time for group B was longer than group A, (90±15.6 minutes for group A (range 60-120) and 150±10.12 minutes for group B(range 120-180 ).. Conclusion:The therapeutic effect of LSG is more significantly observed in patients with BMI less than 50 kg/m2, there is increase in probability of early postoperative complications with increasing body mass index (BMI),.

Outcomes of a novel bariatric stent in the management of sleeve gastrectomy leaks: a multicenter study

BackgroundThe management of laparoscopic sleeve gastrectomy leaks remains a challenge. This can be treated with placement of self-expandable metal stents, which are most effective in the acute and early settings. However, migration is a frequent adverse event (AE). Novel, fully covered stents with a larger proximal flare to limit migration designed specifically to treat postsleeve leaks were recently introduced. ObjectivesThe aim of this study was to evaluate the safety and efficacy of a novel stent specifically designed for postsleeve leaks treatment. SettingMulticenter retrospective study. MethodsThis is a multicenter study, including patients with acute and early post laparoscopic sleeve gastrectomy leaks, treated with a large bariatric stent. The outcomes include technical success, clinical success, and safety profile. A multivariable regression was performed to assess predictors of success. ResultsThirty-seven patients were included (10 acute and 27 early leaks), with 30 stents in the postpyloric (POST) and 7 in the prepyloric position. Technical success was 100%. Mean stent dwell time was 29.08 days. Clinical success was achieved in 78.37%. Leak duration, leak size, and stent dwell time did not correlate with clinical success. During follow-up, 8 patients had stent migration (21.62%) and all were in a POST position. AE poststent removal were also evaluated (prepyloric: 57.14% vs POST: 33.3%, P = .45). There was no difference between prepyloric and POST position in the severe AE analysis. ConclusionsThis novel, large-caliber, fully covered stent specifically designed for sleeve leaks appears to be effective at treating acute and early leaks. However, the large flanges and long stent length do not appear to reduce migration rate and may be associated with higher overall severe AE rates. Avoiding placement in the POST position may help mitigate migration risk; however, owing to the risk profile this stent should be used with caution.

Thoracic Complications of Bariatric Surgeries: Overlooked Entities.

Bariatric surgeries are increasingly performed to treat obesity worldwide. The currently available literature on these surgeries mainly focuses on their abdominal complications, giving less attention to their thoracic ones. Hence, the present work aimed to highlight the thoracic complications associated with bariatric surgeries. A retrospective descriptive study was performed and involved the review of the medical charts of 390 patients who underwent different bariatric surgeries between January 2014 and January 2017 in our hospital or who were referred to us from other centers after their specific operations. The data of patients who developed thoracic complications and who required further intervention were identified and categorized by the modality of diagnosis, outcome, duration of hospital and ICU stays, and management. Patients with a history of a preexisting pulmonary disease were excluded. Twenty-six patients were observed to have thoracic complications secondary to their bariatric surgeries. Twenty-two patients (84.6%) received post-laparoscopic sleeve gastrectomy (LASG). Nine patients (34.6%) required ICU stays. Twenty patients (76.9) had incidences of pleural effusion in the postoperative period. The mean duration of hospital and ICU stays were 4.4 ± 11.67days and 15 ± 19.36days, respectively. Other reported thoracic complications included esophageal perforations, thoracic empyema, septic pericardial effusion, and pancreaticopleural fistula. Bariatric surgeries are safe procedures in selected patients. There is a significant amount of literature describing abdominal, nutritional, neurological, and even ophthalmic complications after bariatric surgeries. Being that they are relatively rare, thoracic complications are underreported in the literature. The management of thoracic complications after bariatric surgery requires awareness and a high index of suspicion to prevent further morbidities and mortalities.

Bronchoesophageal fistula, a rare complication post laparoscopic sleeve gastrectomy: A case report and literature review

Acquired bronchoesophageal fistula (BEF) and tracheoesophageal fistula are rare disorders that result from medical disease or secondary to a complication of a procedure, most commonly due to the prolonged high-pressure endotracheal or tracheostomy cuffs in the presence of nasogastric tube in the esophagus. Rarely, esophageal injuries can result in BEF; presentation is usually after 1 week of the procedure, and the treatment is esophageal stenting or clips in the early phase, and failure will need definitive surgical management. Here, we present our case of a complex BEF post laparoscopic sleeve gastrectomy that required endoscopic and surgical management. This is a case report and literature review.

Porto-mesenteric vein thrombosis following laparoscopic sleeve gastrectomy for morbid obesity: Case series and literature review

BackgroundPortal vein thrombosis is a rare and a potentially lethal complication of Laparoscopic sleeve gastrectomy. In this series, we describe the presentation, treatment, and outcome of 5 cases of PMVT post-laparoscopic sleeve gastrectomy (LSG) treated successfully at our hospital. Case reportFive patients presented to our emergency department with diffuse abdominal pain associated with anorexia, nausea and vomiting after laparoscopic sleeve gastrectomy (LSG). Computed tomography (CT) scan showed evidence of portal, mesenteric and splenic vein thrombosis and small bowel ischemia in three patients. Two patients were treated only with anticoagulant and the other three patients were treated with surgery in the form of diagnostic laparoscopy converted to laparotomy with Small bowel resection. ConclusionPortal and mesenteric venous thrombosis after laparoscopic sleeve gastrectomy is an unusual complication but it has life threatening consequences if it is not diagnosed early and treated adequately. The patients with porto-mesenteric venous thrombosis (PMVT) usually present themselves with vague abdominal symptoms. As so, the physicians should have high index of suspicion to recommend computed tomography (CT) abdomen to confirm diagnosis and start adequate treatment.

Portomesenteric Venous Thrombosis Post-Laparoscopic Sleeve Gastrectomy: Do Energy Systems Pose as Instigating Factor to This Infrequent Complication?

Background:Portomesenteric venous thrombosis (PMVT), a rare complication after laparoscopic sleeve gastrectomy (LSG). Severe consequences are owed to a high risk of bowel ischemia. Our aim is to present a series of patients who developed PMVT after LSG, highlighting the potential role of the vessel sealer and divider as a risk factor.Methods:Medical records of seven patients who underwent LSG and developed PMVT from April 2010 to January 2019, at King Abdullah University Hospital and Jordan University Hospital, Jordan were reviewed. Our findings were studied, audited, and compared with published data.Results:A sum of 4900 patients underwent LSG, 7 (0.14%) developed PMVT. The mean age and body mass index (BMI) were 36.8 years and 45 kg/m2, respectively. Four were women. Epigastric pain radiating to the back was the presenting symptom at a median time of 9 days after surgery. Computed tomography (CT) of the abdomen confirmed the diagnosis. Five patients presented with a total portal vein thrombosis (PVT), one with splenic vein thrombosis and one with dual portal and mesenteric vein thrombosis.Conclusion:Portomesenteric venous thrombosis is a relatively uncommon complication following LSG. Early recognition is required to avoid catastrophic outcomes. The role of energy systems in the development of PMVT remains unknown and requires further elaboration.

A prospective study of gastro-oesophageal reflux disease symptoms and quality of life 1-year post-laparoscopic sleeve gastrectomy.

Introduction:There are concerns that laparoscopic sleeve gastrectomy (LSG) can cause severe gastro-oesophageal reflux disease (GORD). The aim of this study was to assess GORD symptoms and quality of life following LSG.Methods:A prospective study of patients undergoing LSG (2014–2016) was performed with follow-up by DeMeester Reflux/Regurgitation Score, Bariatric Quality of Life Index (BQLI) and Bariatric Analysis and Reporting Outcome System (BAROS) Score pre-operatively, 6 months and 1-year post-operatively.Results:Twenty-two patients were studied. Mean modified DeMeester Reflux/Regurgitation Score improved from 2.25 (±0.67) pre-operatively to 0.81 (±0.25) at 12 months (P = 0.04). At 12 months, two patients had symptomatic reflux, but overall satisfaction score was unaffected. Mean BQLI Score underwent a non-significant improvement at 12 months. BAROS Score showed all patients to have excellent (n = 19) or very good (n = 3) results (12 months).Conclusion:GORD symptoms improve for most patients’ 1-year post-operatively. A small proportion of patients will develop troublesome GORD, but overall satisfaction remains high.

A195 - An Evaluation of the Utility of Routine Pathological Examination of the Gastric Remnant Post-Sleeve Gastrectomy

Background: Post-laparoscopic sleeve gastrectomy (LSG) resected specimens are routinely sent for pathologic evaluation. In our program where patients undergo pre-operative endoscopy (EGD) with biopsies, we questioned the utility of sending all specimens to pathology if we additionally examined specimens on the backtable post-LSG. We hypothesized a similar incidence of microscopic findings between endoscopic and surgical specimens, and gross findings between specimens examined by surgeons and pathologists.

A335 - Identification of bacterial and fungal Pathogens in patients with post Laparoscopic Sleeve Gastrectomy leakage

A335 - Identification of bacterial and fungal Pathogens in patients with post Laparoscopic Sleeve Gastrectomy leakage

A360 - Is There a Correlation Between Comorbidities and Post Laparoscopic Sleeve Gastrectomy Gastric Stenosis?

Background: Gastric Stenosis (GS) has been reported in 4% of Laparoscopic sleeve gastrectomy (LSG) cases. No studies have been suggested a possible correlation between the incidences of post LSG stricture and preoperative comorbidities. The aim of this study is to analyze the possible association between preoperative comorbidities and LSG stenosis in our bariatric population.

The role of MDCT study to assess postoperative acute complications of laparoscopic sleeve gastrectomy (LSG)

Background and objectiveLaparoscopic sleeve gastrectomy become widely employed and accepted operation in between Arab population as a permanent solution for morbid obesity. There are many acute complications associated with LSG such postoperative leaks or bleeding, abscess formation, splenic infarction and portal vein thrombosis. The purpose of the study is to present how multidetector CT is beneficial as a screening investigation to detect these complications. MethodsWe retrospectively review CT images done in the first week post operative for280 patients subjected to LSG the center in the period between July 2017-December 2017 (average age 39.5 years old). Resultsthe leak was suspected in 3 patients documented by a direct leak of contrast in one of them, 2 patients active bleeding was clinically suspected, but the exact site of bleeding could not be identified by CT, 15 patients had serous fluid collection, splenic infarction was noticed in 18 patients, 3 patients developed postoperative hematoma one of them become infected, anterior abdominal wall hematoma seen in 5 patients, one patient developed portal vein thrombosis. ConclusionCT is an important imaging tool to diagnose post LSG complications.

The effects of provider-prescribed obesogenic drugs on post-laparoscopic sleeve gastrectomy outcomes: a retrospective cohort study.

Background:Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed bariatric procedures and has proven effective in providing weight loss. However, considerable variance has been noted in the degree of weight loss. Physician prescription practices may be negatively affecting weight loss post-LSG and, thus, contributing to the broad range of weight loss outcomes. The aim of our study was to determine whether commonly prescribed obesogenic medications negatively affect weight loss outcomes post-LSG.Subjects/Methods:This single center retrospective cohort study performed at a University hospital included 323 patients (≥18 years) within University California, San Diego Healthcare System who underwent LSG between 2007 and 2016. We identified a list of 32 commonly prescribed medications that have weight gain as a side effect. We compared the percent excess weight loss (%EWL) of patients divided into two groups based on post-LSG exposure to obesogenic medications. A linear regression model was used to analyze %EWL at 12 months post-LSG while controlling for age, initial body mass index (BMI), and use of leptogenic medications.Results:150 patients (Meds group) were prescribed obesogenic medications within the one-year post-LSG follow up period, whereas 173 patients (Control group) were not prescribed obesogenic medications. The Meds group lost significantly less weight compared to the Control group (%EWL ± SEM at 12 months 53.8 ± 2.4 n=78, 65.0 ± 2.6, n=84 respectively, P = 0.002). This difference could not be attributed to differences in age, gender, initial BMI, co-morbidities, or prescription of leptogenic medications between the two groups.Conclusions:The use of provider-prescribed obesogenic medications was associated with worse weight loss outcomes post-LSG. Closer scrutiny of patient medications may be necessary to help improve outcomes of weight loss treatments.

Identification of Bacterial and Fungal Pathogens in Patients with Post-Laparoscopic Sleeve Gastrectomy Leakage.

Post-laparoscopic sleeve gastrectomy (LSG) leak leads to serious complications, and death may occur. The microbial pattern should be established in order to plan empirical antimicrobial therapy. The intra-abdominal leaks post-LSG were cultured and reviewed. Microbial cultures collected from all post-sleeve leakage cases managed at the King Khalid University Hospital (KKUH) from May 2011 until April 2016 were reviewed. A total of 31 patients with positive leak post-LSG were included. The mean presentation time was postoperative day 12. Computed tomography (CT) was done for all patients on presentation with CT-guided aspiration and drainage next day. Samples from the collection were aspirated first for culture then a pigtail drain was kept in place. The average time of drain removal was on the 75th postoperative day. A total of 28 patients (90.3%) had positive culture results. Candida species were the most common organism isolated from 19 patients (61.2%), among them, 10 (32.2%) were positive for Candida species only. Positive bacterial cultures were found in 18 patients (58%). Majority of which single bacterial pathogen isolate, only seven patients had two organisms, and four patients had three organisms. Klebsiella pneumoniae was the most frequent isolated bacteria [8 patients (44.4%)] followed by Streptococcus and Pseudomonas species. Candida albicans was the most common Candida species isolated, 13 patients (68.4%). Fungal microbes isolated from post-LSG leak collection are common and could be considered in the primary empirical therapy. The antibiotic choice for the leak should cover Klebsiella, Streptococcus, and Pseudomonas until definitive culture results are obtained.