Morbid obesity - JSLS

Chronic Fistula After Revision Laparoscopic Sleeve Gastrectomy

SLS — Tue, 02 Dec 2014 15:25:19 +0000

Giuseppe S. Sica, MD, PhD, Marco D’Eletto, MD, Cristina Fiorani, MD, Andrea Divizia, MD, Paolo Gentileschi, MD, Domenico Benavoli, MD, Manfredi Tesauro, MD, PhD, Achille L. Gaspari, MD

Department of General Surgery, Tor Vergata University of Rome, Rome, Italy (all authors).

ABSTRACT

Laparoscopic sleeve gastrectomy (LSG) is a safe and effective bariatric surgery procedure. Leaks along the staple line are serious complications of the procedure and can result in significant morbidity. Treatment depends on the timing, site, and clinical consequence of the leak. We describe the case of a young, formerly obese woman who presented with a chronic gastric fistula at the esophagogastric junction after an LSG. Treatment of this complication required multiple interventions by a highly specialized team. Physicians’ decision-making was difficult throughout the entire process, and complete healing of the fistula was accomplished 20 months after the LSG. A multidisciplinary approach is mandatory in the treatment of a chronic fistula from LSG, but there is no standard treatment strategy.

Key Words: Morbid obesity, Laparoscopy, Sleeve gastrectomy.

[gview file=”https://crsls.sls.org/wp-content/uploads/2014/12/14-00108-.pdf”]

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Emergent Sleeve Gastrectomy for Gastric Necrosis Resulting From Lap Band Slippage

SLS — Sat, 15 Nov 2014 17:04:02 +0000

Minal Joshi, MD, Krystyna Kabata, PA-C, Srikanth Earhiraju, MD, Michael Baek, MD, Piotr J. Gorecki, MD

Department of Surgery, New York Methodist Hospital, Brooklyn, NY, USA (all authors).

ABSTRACT

Introduction: Laparoscopic adjustable gastric banding (LAGB) has a potential for long-term complications. We report a case of LAGB slippage with extensive gastric necrosis managed with emergent sleeve gastrectomy.

Case Report: A 45-year-old man presented to the emergency department after returning from a distant trip and reported a 3-day history of progressively severe abdominal pain, nausea, vomiting, and fever. He had undergone placement of the LAGB 2 years before this presentation, which resulted in subsequent weight loss of 143 lb and resolution of his comorbidities. On admission, the patient was hypotensive, tachycardic, and oliguric, with evident peritonitis. A computed tomography scan revealed extensive intraperitoneal free air and intra-abdominal fluid. After intravenous fluid resuscitation, he underwent emergent exploratory laparoscopy. A slipped band with gastric prolapse and extensive gastric necrosis were found, with multiple perforations involving most of the greater curvature of the stomach. The LAGB was explanted and a laparoscopic sleeve gastrectomy was performed. A liquid diet was introduced on postoperative day 4. Immediate recovery was prolonged because of acute-onset chronic renal failure and requirement for optimization of nutrition. The patient was discharged home on postoperative day 13 and had a subsequent uneventful recovery.

Conclusion: Gastric prolapse complicated by gastric necrosis is a rare life-threatening complication of LAGB. Once acute LAGB slippage is suspected, urgent attention and treatment are needed to minimize the chance of gastric ischemia. Laparoscopic explanation of LAGB and emergent sleeve gastrectomy may be considered in similar clinical settings to optimize the outcome and minimize the morbidity of near total or total gastrectomy.

Key Words: Laparoscopic adjustable gastric banding, Morbid obesity, Gastric necrosis, Sleeve gastrectomy, Gastric prolapse, Lap band slip.

[gview file=”https://crsls.sls.org/wp-content/uploads/2014/11/13-00180.pdf”]

The post Emergent Sleeve Gastrectomy for Gastric Necrosis Resulting From Lap Band Slippage first appeared on JSLS.

Jejunal Obstruction After Complete Transmural Gastric Band Migration

SLS — Sat, 15 Nov 2014 03:51:47 +0000

Florian Primavesi, MD, Tarkan Ja Ìˆger, MD, Michael Baschata, MD,

Dietmar Ofner, MD, MAS, MSc, FACSDepartment of Surgery, Paracelsus Medical University, Salzburg, Austria (all authors).

ABSTRACT

Introduction: Surgery for morbid obesity is constantly gaining popularity around the world, and laparoscopic adjustable gastric banding is among the most accepted standard procedures. Lately, growing evidence for long-term complications has been reported with this particular technique. While band erosion is described in~1% of patients, complete transmural migration is scarce but may lead to acute intestinal obstruction.

Case Description: We present the case of a 55-year-old man with the rare but potentially life-threatening late complication of a complete band migration and consecutive intestinal obstruction 12 years after laparoscopic adjustable gastric banding. Intraoperative findings showed ischemic pressure ulcers and kinking of a small bowel loop due to adhesions and the migrated band device; thus, partial jejunal resection was necessary. The development of a pronounced wound infection required prolonged ambulatory wound care, but ultimately there was no permanent morbidity.

Discussion: Our report aims to raise awareness of possible long-term problems in bariatric surgery, especially after gastric banding. It demonstrates the importance of continuous supervision of obesity patients including regular assessments to avoid and detect complications even years after surgery.

Key Words: Band migration, Laparoscopic gastric banding, Long-term complications, Morbid obesity, Small-bowel obstruction.[gview file=”https://crsls.sls.org/wp-content/uploads/2014/11/13-00158.pdf”]

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