Role of Rendezvous-Procedure in the Treatment of Complications after Laparoscopic Sleeve Gastrectomy

Introduction: Laparoscopic sleeve gastrectomy is one of the most commonly performed bariatric procedures worldwide with good results, high patient acceptance, and low complication rates. The most relevant perioperative complication is the staple line leak. For the treatment of this complication, endoscopic negative pressure therapy has proven particularly effective. The correct time to start endoscopic negative pressure therapy has not been the subject of studies to date. Methods: Twelve patients were included in this retrospective data analysis over three years. Endoscopic negative pressure therapy was carried out using innovative open pore suction devices. Patients were treated with simultaneous surgery and endoscopy, so called rendezvous-procedure (Group A) or solely endoscopically, or in sequence surgically and endoscopically (Group B). Therapy data of the procedures and outcome measures, including duration of therapy, therapy success, and change of treatment strategy, were collected and analysed. Results: In each group, six patients were treated (mean age 52.96 years, 4 males, 8 females). Poor initial clinical situation, time span of endoscopic negative pressure therapy (Group A 31 days vs. Group B 18 days), and mean length of hospital stay (Group A 39.5 days vs. Group B 20.17 days) were higher in patients with rendezvous procedures. One patient in Group B died during the observation time. Discussion: Rendezvous procedures for patients with staple line leaks after sleeve gastrectomy is indicated for serious ill patients with perigastric abscesses and in need of laparoscopic lavage. The one-stage complication management with the rendezvous procedure seems not to result in an obvious advantage in the further outcome in patients with staple line leaks after laparoscopic sleeve gastrectomy.

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Succesful Management of Laparoscopic Sleeve Gastrectomy Leak with Negative Pressure Therapy

Obesity Surgery ◽

10.1007/s11695-017-2752-0 ◽

2017 ◽

Vol 27 (9) ◽

pp. 2452-2453 ◽

Cited By ~ 2

Author(s):

Marta Cuadrado Ayuso ◽

Rocío Franco Herrera ◽

Jesús Lago Oliver

Keyword(s):

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Negative Pressure ◽

Negative Pressure Therapy ◽

Pressure Therapy

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Response to Letter to the Editor: Successful Management of Laparoscopic Sleeve Gastrectomy Leak with Negative Pressure Therapy

Obesity Surgery ◽

10.1007/s11695-017-2753-z ◽

2017 ◽

Vol 27 (8) ◽

pp. 2168-2169

Author(s):

Abdelrahman A. Nimeri

Keyword(s):

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Negative Pressure ◽

Negative Pressure Therapy ◽

Successful Management ◽

Pressure Therapy ◽

Letter To The Editor

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Endoscopic Negative Pressure Therapy (ENPT) Is Superior to Stent Therapy for Staple Line Leak After Sleeve Gastrectomy: a Single-Center Cohort Study

Obesity Surgery ◽

10.1007/s11695-021-05287-z ◽

2021 ◽

Author(s):

Rami Archid ◽

Fateh Bazerbachi ◽

Barham K. Abu Dayyeh ◽

Felix Hönes ◽

Suhaib J. S. Ahmad ◽

...

Keyword(s):

Sleeve Gastrectomy ◽

Adverse Events ◽

Negative Pressure ◽

Endoscopic Treatment ◽

Staple Line ◽

Metallic Stent ◽

Single Center ◽

Negative Pressure Therapy ◽

Pressure Therapy ◽

Staple Line Leak

Abstract Purpose Staple line leak (SLL) is a serious complication after sleeve gastrectomy (SG). Common endoscopic treatment options include self-expandable metallic stent (SEMS), endoscopic internal drainage (EID), and endoscopic closure. The endoscopic negative pressure therapy (ENPT) is a promising treatment option combining temporary sealing of the defect with drainage of the inflammatory bed. In this study, we compare the outcome of ENPT and SEMS for the treatment of SLL following SG. Materials and Methods A retrospective cohort of 27 patients (21 females) treated at a single center for SLL after SG was included. ENPT was primary therapy for 14 patients and compared with 13 patients treated primarily using SEMS. Results ENPT was associated with a significant reduction of hospital stay (19 ± 15.1 vs. 56.69 ± 47.21 days, p = 0.027), reduced duration of endoscopic treatment (9.8 ± 8.6 vs. 44.92 ± 60.98 days, p = 0.009), and shorter transabdominal drain dwell time (15 (5–96) vs. 45 (12–162) days, p = 0.014) when compared to SEMS. Whereas endoscopic management was successful in 12/14 (85.7%) of patients from the ENPT group, SEMS was successful in only 5/13 (38.5%) of patients (p = 0.015). Furthermore, ENPT was associated with a significant reduction of endoscopic adverse events compared with SEMS (14.3% vs. 76.92% p = 0.001). Conclusion Compared with SEMS, ENPT is effective and safe in treating SLL after SG providing higher success rates, shorter treatment duration, and lower adverse events rates.

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Discussion: Low Complication Rates Using Closed-Incision Negative-Pressure Therapy for Panniculectomies: A Single-Surgeon, Retrospective, Uncontrolled Case Series

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000007039 ◽

2020 ◽

Vol 146 (2) ◽

pp. 398-400

Author(s):

Alexander Pong ◽

Giorgio Giatsidis

Keyword(s):

Negative Pressure ◽

Case Series ◽

Complication Rates ◽

Negative Pressure Therapy ◽

Pressure Therapy

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Endoscopic Insertion Of A Self-Expandable Stent Combined With Laparoscopic Rinsing Of Peritoneal Cavity As A Method For Staple Line Leaks Treatment In Patients Post Laparoscopic Sleeve Gastrectomy

Polish Journal of Surgery ◽

10.1515/pjs-2015-0048 ◽

2015 ◽

Vol 87 (5) ◽

Cited By ~ 1

Author(s):

Maciej Matłok ◽

Piotr Major ◽

Michał Pędziwiatr ◽

Marek Winiarski ◽

Piotr Budzyński ◽

...

Keyword(s):

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Peritoneal Cavity ◽

Staple Line ◽

Results Of Treatment ◽

Staple Line Leaks ◽

Endoscopic Insertion ◽

The Mean ◽

Mean Time

AbstractCurrently, laparoscopic sleeve gastrectomy is one of bariatric surgeries most commonly performed in the world. The most frequent complications of surgeries of this type, with the highest mortality rate, include bleeding into the GI tract and peritoneal cavity, and sleeve staple line leaks. These severe complications prolong the hospital stay, and often are a cause of patient’s death. While in a case of bleeding the procedure appears to be obvious, so far no uniform and standard guidelines have been established for the group of patients with staple line leaks.was to report results of treatment for staple line leaks following laparoscopic sleeve gastrectomy with a laparoscopic procedure and simultaneous endoscopic insertion of a self-expandable stent.152 laparoscopic sleeve gastrectomies were performed from April 2009 to December 2014. The BMI median was 46.9, and the age median was 42 years. Staple line leaks developed in 3 out of 152 people (1.97%). All patients who developed this complication were included in the study. The treatment involved laparoscopic revision surgery with simultaneous endoscopic insertion of a self-expandable stent (Boston Scientific, Wallflex Easophageal Stent, 150×23 mm) into the gastric stump during gastroscopy.Leaks following laparoscopic sleeve gastrectomy were diagnosed on day 5 after the procedure, on average. Intervention consisting of laparoscopy and endoscopic insertion of a self-expandable stent was initiated within 14 hours of diagnosing the leak, on average. The mean time for which the stent was kept was 5 weeks (4–6 weeks). Stenting proved to be fully effective in all patients, where after discharging home, a cutaneous fistula, periodically (every 2-3 weeks) discharging several millilitres of matter, persisted in one patient. The mean time for the leak healing in 2 patients, in whom the described method was successful in treatment of this complication, was 37 days. No patient died in the perioperative or follow-up period.The proposed method for treatment of staple line leaks following laparoscopic sleeve gastrectomy by combined laparoscopic rinsing and draining of the peritoneal cavity and endoscopic insertion of a self-expandable stent is an interesting and worth recommending method for treatment of this complication.

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Hiatoplasty with Crura Buttressing versus Hiatoplasty Alone during Laparoscopic Sleeve Gastrectomy

Gastroenterology Research and Practice ◽

10.1155/2017/6565403 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 9

Author(s):

Andrea Balla ◽

Silvia Quaresima ◽

Pietro Ursi ◽

Ardit Seitaj ◽

Livia Palmieri ◽

...

Keyword(s):

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Esophageal Hiatus ◽

Consecutive Series ◽

Obese Patients ◽

Mesh Placement ◽

Significant Difference ◽

Group A ◽

Group B

Introduction. In obese patients with hiatal hernia (HH), laparoscopic sleeve gastrectomy (LSG) with cruroplasty is an option but use of prosthetic mesh crura reinforcement is debated. The aim was to compare the results of hiatal closure with or without mesh buttressing during LSG. Methods. Gastroesophageal reflux disease (GERD) was assessed by the Health-Related Quality of Life (GERD-HRQL) questionnaire before and after surgery in two consecutive series of patients with esophageal hiatus ≤ 4 cm2. After LSG, patients in group A (12) underwent simple cruroplasty, whereas in group B patients (17), absorbable mesh crura buttressing was added. Results. At mean follow-up of 33.2 and 18.1 months for groups A and B, respectively (p=0.006), the mean preoperative GERD-HRQL scores of 16.5 and 17.7 (p=0.837) postoperatively became 9.5 and 2.4 (p=0.071). In group A, there was no difference between pre- and postoperative scores (p=0.279), whereas in group B, a highly significant difference was observed (p=0.002). The difference (Δ) comparing pre- and postoperative mean scores between the two groups was significantly in favor of mesh placement (p=0.0058). Conclusions. In obese patients with HH and mild-moderate GERD, reflux symptoms are significantly improved at medium term follow-up after cruroplasty with versus without crura buttressing during LSG.

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