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

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.

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

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.

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

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

Stapling technology with triple-row and enhanced staple configurations evaluated in a series of 124 consecutive laparoscopic vertical gastrectomies

Background: Laparoscopic sleeve gastrectomy (LSG) is a procedure frequently used to treat morbid obesity, due to its simplicity compared to other bariatric techniques. However, LSG can lead to serious complications, such as gastric leakage and bleeding from the staple line. To reduce these complications, seroserosal reinforcement of the mechanical suture line after gastrectomy is generally recommended. In recent decades, studies have focused on the safety of anastomosis with staples, especially compared to manual sewing techniques. Since studies on the improvement of stapling technology are limited, this study arises to compare the clinical results of staple line oversewing versus stapling technology with triple-row and enhanced staple configurations in laparoscopic sleeve gastrectomy.Methods: A retrospective review from a prospectively maintained database of 124 laparoscopic vertical gastrectomies performed at single centre between March 2010 and December 2016. Patients were divided into two groups, with comparable anthropometric parameters and inclusion criteria. Seroserosal reinforcement was used in the first group, and stapling technology with triple-row and enhanced staple configurations in the second. Rates of anastomotic leakage, bleeding, reoperation, and 30-day mortality were compared.Results: In Group 1 the average surgical time was 125 min, whereas in Group 2 it was 87 min. No differences were found between the two groups regarding leakage or bleeding of the staple line.Conclusions: The use of triple-row stapling devices during laparoscopic vertical gastrectomy enables surgical time to be reduced. Further high-quality studies to evaluate the efficacy and effectiveness of stapling technology with triple-row and enhanced staple configurations are needed.