Division of General Surgery and Bariatric Center of Excellence, Department of Medicosurgical Sciences and Biotechnology, La Sapienza University of Rome, Latina, Italy (all authors).

ABSTRACT

Introduction: Laparoscopic sleeve gastrectomy (LSG) is a safe and effective procedure for losing weight and gaining control of obesity-related comorbidities. However, it is associated with postoperative complications such as bleeding, leak, and midgastric stenosis. Splenic and hepatic abscesses have been reported as unusual and rare complications after primary LSG. We report a case of splenic and concomitant hepatic abscesses after primary LSG, successful minimally invasive management, and midterm follow-up.

Case Description: We report a complex case of splenic abscess with satellite hepatic abscess plus splenic thrombosis (0.1%) diagnosed 67 days after LSG. This unusual complication was managed by a minimally invasive approach (spleen sparing) with complete resolution after 35 days. After 18 months of follow-up, the patient showed complete resolution of the splenic and liver abscesses and progressive loss of excess weight.

Conclusion: TIn high-volume centers, rare and life-threatening complications such as splenic and hepatic abscesses may be observed. The minimally invasive approach could represent an effective option of avoiding splenectomy in selected cases.

Key Words: Splenic and hepatic abscess, Sleeve gastrectomy, Complications, Thrombosis.

The post Splenic and Concomitant Liver Abscess After Laparoscopic Sleeve Gastrectomy first appeared on JSLS.

Division of Bariatric Surgery, AZ St. Blasius, Dendermonde, Belgium (all authors).

ABSTRACT

Introduction: Many different medical and surgical modalities have been described for the treatment of late strictures after laparoscopic sleeve gastrectomy (LSG), including observation, endoscopic dilatations, seromyotomy (SM), and wedge resection of the sleeve stomach including the stricture. Strictures after LSG are preventable with the appropriate surgical technique of the LSG: when stenosis is apparent perioperatively, SM or stricturoplasty (SP) of the stenosis may be performed at that time to prevent the development of a stricture.

Case and Technique Description: We present two cases. The first is a 30-year-old morbidly obese woman (body mass index 40 kg/m²) who underwent an LSG at our institution. Stapling was performed over a 34-Fr bougie. After complete transection, a stenosis of the sleeve was observed in the upper part of the stomach. An SP, including a full-thickness longitudinal incision, was performed over the stenotic area and then closed transversely with a full-thickness running suture of resorbable monofilament material 2/0.

The second case is of a 29-year-old woman (body mass index 36 kg/m²) who had a revisional surgery with an adjustable gastric band removal and an LSG performed in one stage at the end of the procedure. A stenosis was detected at the level of the incisura angularis, hence an SM was performed.

In both patients, an omental patch was added over the SP and SM. A drain was left in the abdominal cavity along the SG and remained until discharge from the hospital. A nasogastric tube was placed per routine for 24 hours. The postoperative courses were uneventful for both patients, and they were discharged at postoperative days 3 and 4, respectively.

Conclusion: An intraoperative approach for iatrogenic stenosis in the primary LSG may include SM and SP. Both techniques are challenging and should avoid chronic and long-term complications related to stenosis during primary LSG.

Key Words: Sleeve gastrectomy, Stricture, Stenosis, Stricturoplasty, Complications management.

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The post Intraoperative Prevention of Stenosis for Laparoscopic Sleeve Gastrectomy first appeared on JSLS.

Department of General and Bariatric Surgery, Baptist Health South Florida, Miami, FL, USA (all authors).

ABSTRACT

Introduction: Gastric volvulus occurs primarily when the stomach suffers torsion on itself due to laxity, elongation, or agenesis of the stomach ligamentous attachments or secondary to diaphragmatic hernias. Gastric torsion after sleeve gastrectomy is a rare complication. We present a case report of 3 patients with gastric torsion after sleeve gastrectomy.

Case Description/Technique Description: Three patients with gastric torsion after sleeve gastrectomy were identified. Time between sleeve gastrectomy and gastric torsion symptomatology was 25, 211, and 98 days. Endoscopy established the diagnosis in all patients. Operative findings were organoaxial torsion due to adhesions of the sleeve’s staple line to the liver in all cases. Gastropexy was required in 1 case after laparoscopic lysis of adhesions. Recovery was uneventful for all patients, without torsion recurrence.

Discussion: Because sleeve gastrectomy alters the normal stomach attachments, gastric torsion must be considered after sleeve gastrectomy in patients with any degree of obstruction symptoms, at any time of the postoperative course. Endoscopy is a valuable tool for the diagnosis. Laparoscopic torsion reduction by lysis of adhesions is successful, with or without gastropexy.

Key Words: Gastric volvulus, Gastric torsion, Sleeve gastrectomy, Lysis of adhesions, Gastropexy.

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The post Laparoscopic Management of Gastric Torsion After Sleeve Gastrectomy first appeared on JSLS.

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.

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The post Chronic Fistula After Revision Laparoscopic Sleeve Gastrectomy first appeared on JSLS.

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.

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