Percutaneous embolization for a subacute gastric fistula following laparoscopic sleeve gastrectomy: a case report and literature review

Abstract Background The management for subacute or chronic fistula after bariatric surgery is very complicated and with no standard protocol yet. It is also an Achilles’ heel of all bariatric surgery. The aim of this case report is to describe our experience in managing this complication by percutaneous embolization, a less commonly used method. Case presentation A 23-year-old woman with a body mass index of 35.7 kg/m2 presented with delayed gastric leak 7 days after laparoscopic sleeve gastrectomy (LSG) for weight reduction. Persistent leak was still noted under the status of nil per os, nasogastric decompression, and parenteral nutrition for 1 month; therefore, endoscopic glue injection was performed. The fistula tract did not seal off, and the size of pseudocavity enlarged after gas inflation during endoscopic intervention. Subsequently, we successfully managed this subacute gastric fistula via percutaneous fistula tract embolization (PFTE) with removal of the external drain 2 months after LSG. Conclusions PFTE can serve as one of the non-invasive methods to treat subacute gastric fistula after LSG. The usage of fluoroscopy-visible glue for embolization can seal the fistula tract precisely and avoid the negative impact from gas inflation during endoscopic intervention.

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Gastrobronchial Fistula: A Rare Complication of Postlaparascopic Sleeve Gastrectomy—A Case Report and Literature Review

Case Reports in Radiology ◽

10.1155/2021/6641319 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Mohammed Sabawi ◽

Alhassan Alhasson ◽

Abdul-Rahman Abualruz ◽

Alaa Abdulsattar Al-Taie

Keyword(s):

Bariatric Surgery ◽

Sleeve Gastrectomy ◽

Case Report ◽

Laparoscopic Sleeve Gastrectomy ◽

Rare Complication ◽

Standard Of Care ◽

Gastric Leak ◽

Contrast Study ◽

Diagnostic Modality ◽

Gastrobronchial Fistula

Introduction. Obesity is one of the leading causes of morbidity and mortality in countries all over the world, and its prevalence has been increasing dramatically in recent years. Bariatric surgery is considered the gold standard of care for patients who failed conservative management. Laparoscopic sleeve gastrectomy (LSG) is of increasing popularity. One of its vicious consequences is the development of acquired fistula between the stomach and the tracheobronchial tract due to intractable gastric leak. Case Report. We are presenting a case of a 25-year-old man who underwent laparoscopic sleeve gastrectomy for morbid obesity, which was complicated with the development of gastrobronchial fistula, despite an unremarkable postoperative course. Conclusion. Acquired gastrobronchial fistula due to bariatric surgery is not reported widely in radiologic literature; hence, there is lack of consensus of the diagnostic modality of choice. However, there is a myriad of tests available for diagnosing gastrobronchial fistula, with contrast study of the upper gastrointestinal tract which is the widely accepted diagnostic test.

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Portomesenteric venous thrombosis in a prophylactically anticoagulated obese patient after laparoscopic sleeve gastrectomy: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-03174-w ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Feras Alsannaa ◽

Faisal Albaqami ◽

Mishary Shalhoub

Keyword(s):

Bariatric Surgery ◽

Sleeve Gastrectomy ◽

Case Report ◽

Small Bowel ◽

Laparoscopic Sleeve Gastrectomy ◽

Bowel Ischemia ◽

Morbidity And Mortality ◽

Midline Laparotomy ◽

Vein Thrombosis ◽

Portomesenteric Vein Thrombosis

Abstract Background Obesity is associated with an increased risk of morbidity and mortality, so weight reduction is important. Bariatric surgery is a well-tolerated approach for reducing body weight, with laparoscopic sleeve gastrectomy commonly performed. An uncommon and potentially fatal sequela of laparoscopic sleeve gastrectomy is portomesenteric vein thrombosis, which may result in severe bowel ischemia. Case report A 32-year-old Middle Eastern obese man (body mass index 33) presented to the emergency department with severe, generalized abdominal pain 2 weeks after laparoscopic sleeve gastrectomy. Computed tomography of the abdomen and pelvis revealed extensive acute on chronic portosplenic and superior mesenteric vein thrombosis with associated small bowel ischemia. Laparoscopic exploration was converted to midline laparotomy and an extensive ischemic small bowel resection. Conclusion Laparoscopic sleeve gastrectomy carries a risk of both morbidity and mortality. Venous thromboembolism is a well-known risk of bariatric surgery, but portomesenteric vein thrombosis is also a rare but sometimes serious complication. A high index of suspicion for portomesenteric vein thrombosis to prompt early detection is essential in patients who have undergone laparoscopic sleeve gastrectomy to minimize complications and optimize outcomes. Uncertainty still remains around the optimal dose and duration of anticoagulation after laparoscopic sleeve gastrectomy.

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P49: Conservative management of a large contained gastric leak following laparoscopic sleeve gastrectomy for morbid obesity: Case report and review of the literature

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2008.03.110 ◽

2008 ◽

Vol 4 (3) ◽

pp. 330-331

Author(s):

Elias Chousleb ◽

Litong Du ◽

Stephen Merola

Keyword(s):

Morbid Obesity ◽

Sleeve Gastrectomy ◽

Case Report ◽

Laparoscopic Sleeve Gastrectomy ◽

Conservative Management ◽

Gastric Leak ◽

Review Of The Literature

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Single Incisional Laparoscopic Sleeve Gastrectomy and Adolescent Bariatric Surgery: Case Report and Brief Review

Journal of Metabolic and Bariatric Surgery ◽

10.17476/jmbs.2015.4.2.40 ◽

2015 ◽

Vol 4 (2) ◽

pp. 40-45 ◽

Cited By ~ 2

Author(s):

Young Suk Park ◽

Do Joong Park ◽

Ki Hyun Kim ◽

Dong Jin Park ◽

Sang Hoon Ahn ◽

...

Keyword(s):

Bariatric Surgery ◽

Sleeve Gastrectomy ◽

Case Report ◽

Laparoscopic Sleeve Gastrectomy ◽

Adolescent Bariatric Surgery

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Splenic abscess caused by Streptococcus anginosus following laparoscopic sleeve gastrectomy: a case report of a rare complication of bariatric surgery

Journal of Surgical Case Reports ◽

10.1093/jscr/rjx072 ◽

2017 ◽

Vol 2017 (4) ◽

Cited By ~ 2

Author(s):

Miguel E. Cervera-Hernandez ◽

Dieter Pohl

Keyword(s):

Bariatric Surgery ◽

Sleeve Gastrectomy ◽

Case Report ◽

Laparoscopic Sleeve Gastrectomy ◽

Rare Complication ◽

Splenic Abscess ◽

Streptococcus Anginosus

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Efficacy of laparoscopic sleeve gastrectomy for patient with morbid obesity and type 1 diabetes mellitus: a case report

Surgical Case Reports ◽

10.1186/s40792-020-00989-5 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Hidetaka Ichikawa ◽

Hirofumi Imoto ◽

Naoki Tanaka ◽

Hiroaki Musha ◽

Shojiro Sawada ◽

...

Keyword(s):

Diabetes Mellitus ◽

Bariatric Surgery ◽

Morbid Obesity ◽

Body Weight ◽

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Hba1c Level ◽

Insulin Dose ◽

Body Weight Loss

Abstract Background Bariatric surgery is effective for the treatment of patients with morbid obesity and type 2 diabetes mellitus (T2DM), for body weight loss and glycemic control. However, in Japan, there has been no previous report of the effectiveness bariatric surgery in a case of morbid obesity associated with acute onset type 1 diabetes mellitus (T1DM), in which pancreatic β-cells were destroyed and endogenous insulin was depleted. Case presentation A 36-year-old woman with morbid obesity and T1DM, diagnosed when she was 6 years, was admitted for bariatric surgery. At her first consultation, she had a body weight of 106.7 kg and a body mass index of 42.2 kg/m2. Her HbA1c level was 9.0%, with a required daily insulin dose of 75 units. She underwent laparoscopic sleeve gastrectomy. At 1 year after surgery, her body weight had decreased to 81.0 kg and her body mass index to 32.2 kg/m2. In addition, her daily required dose of insulin had decreased to 24 units, with an improvement in her HbA1c level to 7.7%. Conclusions Although further evidence needs to be accumulated, including long-term outcomes, laparoscopic sleeve gastrectomy may provide an effective treatment for patients with morbid obesity and T1DM for body weight loss, improvement in HbA1c level, and insulin dose reduction.

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Laparoscopic Sleeve Gastrectomy for the Surgical Treatment of Obesity: Is It an Easy Procedure?

Surgical Research - Open Journal ◽

10.17140/sroj-6-e004 ◽

2021 ◽

Vol 6 (1) ◽

pp. e1-e1

Author(s):

Emilio Manno ◽

Keyword(s):

Bariatric Surgery ◽

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Simple Procedure ◽

Longitudinal Gastrectomy ◽

Technical Simplicity ◽

Treatment Of Obesity ◽

Malabsorptive Procedure ◽

Global Registry ◽

Registry Report

Laparoscopic sleeve gastrectomy (LSG) is currently the most performed bariatric procedure in the world. The 4th International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Global registry report (2014-18) estimates 87,015 procedures, equal to 45.9% of all bariatric procedures. Initially performed as the first step of the duodenals witch (biliopancreatic diversion with duodenal switch (BPD-DS)), a very complex malabsorptive procedure invented by a Canadian Surgeon P. Marceau as an evolution of the BPD, invented by N. Scopinaro, an Italian surgeon, LSG established itself in the early 2000s as a stand alone procedure, especially following the observations of Michael Gagner, pioneer of bariatric surgery. Over the years LSG has grown rapidly. The reasons for this popularity are the relative technical simplicity compared to other procedures, efficacy, good quality. For these reasons there has been a real explosion of bariatric surgery: many surgeons, driven by the relative simplicity of the procedure (longitudinal gastrectomy on the guide of a probe), begun to propose this procedure. So is LSG really an effective simple procedure that is good for all patients? Absolutely not. Performing a longitudinal gastrectomy can be simple; performing a good LSG is not.

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