Total gastrectomy after endotherapy failure for management of chronic gastric leakage from sleeve gastrectomy: the end of a nightmare

Chirurgia ◽  
2022 ◽  
Vol 34 (5) ◽  
Author(s):  
Francesca MEOLI ◽  
Diletta CORALLINO ◽  
Livia PALMIERI ◽  
Ingrid E. CORDOVA HERENCIA ◽  
Alessandro M. PAGANINI
Keyword(s):  
Sleeve Gastrectomy ◽  
Total Gastrectomy ◽  
Gastric Leakage

scholarly journals Outcomes of biliopancreatic EUS in patients with surgically altered upper gastrointestinal anatomy: a multicenter study

2020 ◽  
Vol 08 (07) ◽  
pp. E869-E876
Author(s):  
Lorenzo Brozzi ◽  
Maria Chiara Petrone ◽  
Jan-Werner Poley ◽  
Silvia Carrara ◽  
Luca Barresi ◽  
...  
Keyword(s):  
Sleeve Gastrectomy ◽  
Total Gastrectomy ◽  
Success Rates ◽  
Technical Success ◽  
Billroth Ii ◽  
Billroth I ◽  
Tissue Acquisition ◽  
Head Of The Pancreas ◽  
Procedural Success ◽  
Upper Gastrointestinal

Abstract Background and study aims Little is known about outcomes of biliopancreatic endosonography (EUS) in patients with surgically altered upper gastrointestinal (gastrointestinal) anatomy. We aimed to assess the rate of procedural success and EUS-related adverse events (AEs), according to post-surgical anatomies. Patients and methods Retrospective study including patients with post-surgical altered upper gastrointestinal anatomy who underwent EUS for evaluation of the biliopancreatic region between January 2008 and June 2018 at eight European centers. Results Of 242 patients (162 males, mean age 66.4 ± 12.5), 86 had (35.5 %) Billroth II, 77 (31.8 %) pancreaticoduodenectomy, 23 (9.5 %) Billroth I, 19 (7.9 %) distal esophagectomy, 15 (6.2 %) total gastrectomy, 14 (5.8 %) sleeve gastrectomy, and eight (3.3 %) Roux-en-Y. Sleeve gastrectomy, Billroth I, and pancreaticoduodenectomy were associated with high rates of success (100 %, 95.7 %, and 92.2 %, respectively). Visualization of the head of the pancreas was significantly impacted by total gastrectomy, Billroth II, and Roux-en-Y (success rates 6.7 %, 53.7 %, and 57.1 %, respectively). Examination of the pancreatic body and tail was impaired in esophagectomy and total gastrectomy (82.4 % and 71.4 %, respectively). Technical success and diagnostic accuracy of EUS-guided tissue acquisition (EUS-TA) was 78.2 % and 71.3 % (95 % CI, 60.6–80.5), respectively. Four (1.6 %) AEs were observed: one mucosal tearing in a Billroth II patient, one cardiac arrest in a distal esophagectomy patient, one bleed after EUS-TA in a Billroth I patient, and one acute pancreatitis after EUS-TA in a sleeve gastrectomy patient. Conclusions The yield of bilio-pancreatic EUS is dependent on lesion location and surgery type. Before considering EUS in these patients, one must carefully consider whether the lesion may be approachable by EUS.

scholarly journals A Complication of an Endoscopic Pigtail Stent Migration into the Cavity during Deployment as a Treatment for Gastric Leak

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
Abrar A. AlAtwan ◽  
Ali AlJewaied ◽  
Talal AlKhadher ◽  
Mohannad AlHaddad ◽  
Iqbal Siddique
Keyword(s):  
Sleeve Gastrectomy ◽  
Hospital Stay ◽  
Gastrointestinal Surgery ◽  
Stent Migration ◽  
Gastric Leak ◽  
Internal Drainage ◽  
Endoscopic Internal Drainage ◽  
Gastric Leakage ◽  
Pigtail Stent

Gastric leak following gastrointestinal surgery is the most dreadful complication, which implies long hospital stay, morbidities, and not irrelevant mortalities. There is no standard recommendation for treating postlaparoscopic sleeve gastrectomy leak, which makes its management challenging. Endoscopic internal drainage by double-pigtail drains currently became the recommended approach. Complications to this approach include bleeding, ulceration at the tip of the double-pigtail stent, and uncommon migration. Here, we report our experience with drain displacement into the cavity while deployment in a patient who experienced gastric leakage after undergoing sleeve gastrectomy.

Open total gastrectomy with Roux-en-Y reconstruction for a chronic fistula after sleeve gastrectomy

2016 ◽  
Vol 12 (10) ◽  
pp. 1803-1808 ◽  
Author(s):  
Matthieu Bruzzi ◽  
Richard Douard ◽  
Thibault Voron ◽  
Anne Berger ◽  
Franck Zinzindohoue ◽  
...  
Keyword(s):  
Sleeve Gastrectomy ◽  
Total Gastrectomy ◽  
Chronic Fistula ◽  
Open Total Gastrectomy

scholarly journals Laparoscopic Sleeve Gastrectomy with Omentopexy: Is It Really a Promising Method?—A Systematic Review with Meta-analysis

2021 ◽  
Author(s):  
Piotr Zarzycki ◽  
Jan Kulawik ◽  
Piotr Małczak ◽  
Mateusz Rubinkiewicz ◽  
Mateusz Wierdak ◽  
...  
Keyword(s):  
Sleeve Gastrectomy ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Leakage Rate ◽  
Gastric Leak ◽  
Randomized Controlled ◽  
Randomized Controlled Studies ◽  
Gastric Leakage ◽  
Established Technique

Abstract Purpose Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed bariatric procedure worldwide. Omentopexy during LSG is a novel variation of this well-established technique. There are no clear conclusions on indications for this procedure, safeness, and effects of such a method. We aimed to compare the outcomes of laparoscopic sleeve gastrectomy (LSG) with omentopexy (OP) and without omentopexy. Materials and Methods We searched the Medline, EMBASE, and Scopus databases up-to June 2020. Full-text articles and conference abstracts were included for further analysis. This review follows the PRISMA guidelines. Results Of initial 66 records, only 4 studies (N = 1396 patients) were included in the meta-analysis. Our findings showed that LSG with omentopexy had significantly lowered overall morbidity compared to LSG without omentopexy (RR = 0.38; 95% CI [0.15, 0.94]; p=0.04). Gastric leakage rate (RR = 0.17; 95% CI [0.04, 0.76]; p = 0.02) was also significantly lower in LSG with omentopexy. There were no significant differences between groups in length of hospital stay. Conclusions Our meta-analysis showed that LSG with omentopexy may be a feasible procedure for decreasing morbidity and gastric leak rate. However, despite promising results, the procedure needs to be researched more in randomized controlled studies to draw solid conclusions.

scholarly journals Endoscopic septotomy as a treatment for leaks after sleeve gastrectomy

2020 ◽  
Vol 08 (01) ◽  
pp. E70-E75 ◽  
Author(s):  
Ramon Diaz ◽  
Leonard K. Welsh ◽  
Juan Esteban Perez ◽  
Andres Narvaez ◽  
Gerardo Davalos ◽  
...  
Keyword(s):  
Sleeve Gastrectomy ◽  
Total Gastrectomy ◽  
Retrospective Review ◽  
Procedure Time ◽  
Fistula Closure ◽  
Crucial Step ◽  
The World ◽  
Mean Time ◽  
Definitive Management

Abstract Background and study aims Sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure in the world. Leaks are the most feared complications after this procedure. Endoscopic septotomy has been described as a resolution technique that could be useful in the setting of late and chronic leaks. We present our experience in the management of gastric leaks with this advanced endoscopic technique. Patients and methods Retrospective review of patients who have been admitted to our hospital from January 2016 to December 2018. Results Five patients were found. All had their index surgery in outside hospitals. The average age was 51 years (range 40 – 69), and four patients were female. Mean time from LSG to leak presentation was 15 days (range 7 – 25). Mean time from leak presentation to septotomy procedure was 61 days (range 21 – 110). All patients were treated with sleeve dilatation before septotomy using endoscopic achalasia balloons. Mean procedure time was 79 minutes (range 55 – 125). Success was achieved in 80 % of patients, and no complications related to the procedure were identified. One patient underwent total gastrectomy for definitive management. Mean follow-up time was 14.25 months (range 6 – 26), and the average time for fistula closure was 60.25 days. Conclusion Endoscopic septotomy is safe and effective for management of chronic leaks after LSG. Associated non-selective dilatation may be a crucial step to allow distal patency and axis rectification for appropriate leak closure.

scholarly journals CT Fluoroscopy-Guided Drain Placement to Treat Infected Gastric Leakage after Sleeve Gastrectomy: Technical and Clinical Outcome of 31 Procedures

2019 ◽  
Vol 192 (02) ◽  
pp. 163-170
Author(s):  
Jens Schwarz ◽  
Frederik Franz Strobl ◽  
Philipp M Paprottka ◽  
Melvin D’Anastasi ◽  
Fritz W. Spelsberg ◽  
...  
Keyword(s):  
Sleeve Gastrectomy ◽  
Clinical Outcome ◽  
Clinical Success ◽  
High Risk Patient ◽  
Ct Scanner ◽  
Ct Fluoroscopy ◽  
Dose Length Product ◽  
Ct Guided ◽  
Gastric Leakage ◽  
Drain Placement

Purpose To observe the technical and clinical outcome as well as safety of CT fluoroscopy-guided drain placement in the multimodal clinical complication management of superinfected gastric leakage after sleeve gastrectomy. Materials and Methods All consecutive patients who underwent CT fluoroscopy-guided drain placement to treat superinfected postoperative leakage after sleeve gastrectomy in our department between 2007 and 2014 were included in this retrospective study. All interventions were performed on a 16- or 128-row CT scanner under intermittent CT fluoroscopy guidance (15–25 mAs, 120 kV). The technical and clinical success rates as well as complications, additional therapies and patient radiation dose were analyzed. Results 14 patients (mean age: 43.8 ± 11.3 years, mean BMI: 52.9 ± 13.5, 7 women) who underwent a total of 31 CT fluoroscopy-guided drain placement procedures were included. 30 of 31 interventions (96.8 %) were technically successful. 7 patients underwent more than one intervention due to drain obstruction or secondary dislocation or as further treatment. During and after the intervention no procedure-associated complications occurred. In all patients, inflammation parameters decreased within days after the CT-guided intervention. The total interventional dose length product (DLP) was 1561 ± 1035 mGy*cm. Conclusion CT fluoroscopy-guided drain placement has been shown to be a safe minimally invasive procedure that rarely leads to complications for treating superinfected gastric leakage occurring after sleeve gastrectomy. We assume that operative revisions in a high-risk patient group can be avoided using this procedure. Key Points:  Citation Format

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