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Esophageal Perforation After Laparoscopic Sleeve Gastrectomy and Paraesophageal Hernia Repair Managed by Transhiatal Drainage. Int Surg 2021. [DOI: 10.9738/intsurg-d-15-00092.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Laparoscopic sleeve gastrectomy (SG) was first established as a 2-stage procedure in high-risk patients undergoing gastric bypass or biliary pancreatic diversion with duodenal switch. It has since become increasingly used as a primary bariatric procedure. The 2 significant postoperative complications after this procedure are anastomotic staple line leakage or bleeding. True esophageal leaks after sleeve gastrectomy are extremely uncommon. We present a case of contained esophageal perforation after a laparoscopic sleeve gastrectomy and paraesophageal hernia repair managed successfully with laparoscopic-assisted transhiatal drainage. We review the literature on the management of this uncommon but highly morbid complication in patients undergoing bariatric surgery.
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Guzaiz N, Arabi M, Khankan A, Salman R, Al-Toki M, Qazi S, Alzakari A, Al-Moaiqel M. Gastroesophageal stenting for the management of post sleeve gastrectomy leak. A single institution experience. Saudi Med J 2016; 37:1339-1343. [PMID: 27874149 PMCID: PMC5303772 DOI: 10.15537/smj.2016.12.15761] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 09/04/2016] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To retrospectively evaluate the effectiveness of gastroesophageal stenting for post sleeve gastrectomy staple line leaks using removable self-expandable stents. METHODS Between April 2012 and June 2015, 12 consecutive patients (6 males) with mean age of 34 years (21-38 years) presented with staple line leak 1-8 weeks after the operation (mean 2.8 weeks). Patients underwent gastroesophageal stenting by interventional radiology. A total of 23 stents were deployed with mean length of 17.8 cm (7-24 cm) and mean diameter 25.6 mm (18-36 mm). Stent re-insertion was needed in 7 patients (9 procedure), while 6 patients required percutaneous collection drainage and 3 patients required endoscopic glue injection with clipping. Two stent removal procedures were carried out under endoscopic visualization after failed stent capture under fluoroscopy, while the remaining stents were successfully removed by interventional radiology. Results: Stent placement was technically successful in all patients. Stent migration occurred in 6 patients (50%). There is a tendency for stent migration with shorter stent length (R= -0.557, p=0.008). The mean duration of stenting was 60.5 days (14-137 days). All patients underwent stent removal and resumed oral intake with no recurrence of leak at a mean follow up time of 190 days (14-410 days). Complications included gastrointestinal bleeding (n=1), proximal esophageal stricture (n=1) and stent occlusion (n=1). CONCLUSION Gastroesophageal stenting as a primary measure after diagnosis of early post sleeve gastrectomy leak appears to offer a safe and effective alternative option in obviating repeat surgical interventions. Minimally invasive interventions may still be required for the management of persistent leak.
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Affiliation(s)
- Noha Guzaiz
- From the Department of Medical Imaging (Guzaiz), King Abdulaziz Medical City, Makkah, the Departments of Medical Imaging (Guzaiz, Arabi, Khankan, Salman, Al-Toki, Qazi, Al-Moaiqel) and Surgery (Alzakari), King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Mohammad Arabi
- From the Department of Medical Imaging (Guzaiz), King Abdulaziz Medical City, Makkah, the Departments of Medical Imaging (Guzaiz, Arabi, Khankan, Salman, Al-Toki, Qazi, Al-Moaiqel) and Surgery (Alzakari), King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Azzam Khankan
- From the Department of Medical Imaging (Guzaiz), King Abdulaziz Medical City, Makkah, the Departments of Medical Imaging (Guzaiz, Arabi, Khankan, Salman, Al-Toki, Qazi, Al-Moaiqel) and Surgery (Alzakari), King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Refaat Salman
- From the Department of Medical Imaging (Guzaiz), King Abdulaziz Medical City, Makkah, the Departments of Medical Imaging (Guzaiz, Arabi, Khankan, Salman, Al-Toki, Qazi, Al-Moaiqel) and Surgery (Alzakari), King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Al-Toki
- From the Department of Medical Imaging (Guzaiz), King Abdulaziz Medical City, Makkah, the Departments of Medical Imaging (Guzaiz, Arabi, Khankan, Salman, Al-Toki, Qazi, Al-Moaiqel) and Surgery (Alzakari), King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Shahbaz Qazi
- From the Department of Medical Imaging (Guzaiz), King Abdulaziz Medical City, Makkah, the Departments of Medical Imaging (Guzaiz, Arabi, Khankan, Salman, Al-Toki, Qazi, Al-Moaiqel) and Surgery (Alzakari), King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Abdulmohsin Alzakari
- From the Department of Medical Imaging (Guzaiz), King Abdulaziz Medical City, Makkah, the Departments of Medical Imaging (Guzaiz, Arabi, Khankan, Salman, Al-Toki, Qazi, Al-Moaiqel) and Surgery (Alzakari), King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Mohammad Al-Moaiqel
- From the Department of Medical Imaging (Guzaiz), King Abdulaziz Medical City, Makkah, the Departments of Medical Imaging (Guzaiz, Arabi, Khankan, Salman, Al-Toki, Qazi, Al-Moaiqel) and Surgery (Alzakari), King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
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