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Albeiti T, Khogeer A, Elbahrawy A. An Unusual Complication of Internal Hernia Post-laparoscopic Sleeve Gastrectomy: A Video Case Report. Cureus 2024; 16:e71146. [PMID: 39525259 PMCID: PMC11546282 DOI: 10.7759/cureus.71146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2024] [Indexed: 11/16/2024] Open
Abstract
Internal hernia is a well-recognized complication after laparoscopic Roux-En-Y gastric bypass. Recently, it has been recognized after laparoscopic one-anastomosis gastric bypass. Alteration of bowel anatomy was put as the cause of internal hernia after these procedures. Laparoscopic sleeve gastrectomy (SG) is one of the most commonly performed bariatric procedures worldwide; it was hypothesized that internal hernia could not occur after sleeve gastrectomy. We report in a video a case of internal hernia that occurred post laparoscopic sleeve gastrectomy and its concomitant management. Data on the case of post-SG internal hernia were collected retrospectively and reported in a video with its intra-operative findings and concomitant management. The patient is a 35-year-old male. He underwent laparoscopic sleeve gastrectomy, which was complicated by a leak. It was managed conservatively with optimal clinical response. He presented seven years after his surgery to the emergency department with a history of multiple episodes of severe left upper abdominal pain. a CT scan was performed, showing suspicion of an internal hernia. The patient was taken for emergency laparoscopic exploration. Intra-operatively, there was a band of adhesion from a previous leak site connecting a loop of proximal jejunum to the anterior abdominal wall, forming a 5 cm defect. Through it, a loop of bowel was found herniating with partial twisting of its mesentery and engorgement of its vessels. In addition, there were multiple adhesions between bowel loops. The herniated bowel loop was reduced with no evidence of ischemia. The adhesive band was resected using a laparoscopic linear stapler. The bowel was fully inspected from the ileocecal valve up to the duodenojejunal (DJ) flexure, and a full adhesiolysis was performed. The patient recovered well. He was discharged on day one postoperatively. He was followed up with a complete resolution of his symptoms and no complications. We conclude that an internal hernia could occur as a long-term complication of sleeve gastrectomy leaks. A high index of suspicion should be applied when dealing with vague abdominal pain post-bariatric surgery. The laparoscopic approach was safe and feasible.
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Affiliation(s)
- Talat Albeiti
- General Surgery, King Abdullah Medical City, Makkah, SAU
| | | | - Aly Elbahrawy
- Specialized Surgery, King Abdullah Medical City, Makkah, SAU
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Sun X, Yao L, Kang X, Yu W, Kitaghenda FK, Ibn Rashid MS, Taguemkam AN, Hong J, Dong Z, Sun X, Zhu X. Outcome of bariatric surgery in patients with unexpected liver cirrhosis: A multicenter study from China. LIVER RESEARCH 2024; 8:172-178. [PMID: 39957746 PMCID: PMC11771253 DOI: 10.1016/j.livres.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 07/26/2024] [Accepted: 08/21/2024] [Indexed: 01/03/2025]
Abstract
Background and aims Liver cirrhosis is a complex disease that may result in increased morbidity and mortality following bariatric surgery (BS). This study aimed to explore the outcome of BS in patients with unexpected cirrhosis, focusing on postoperative complications and the progression of liver disease. Methods A retrospective study of bariatric patients with cirrhosis from four centers in China between 2016 and 2023 was conducted, with follow-up for one year after BS. The primary outcome was the safety of BS in patients with unexpected cirrhosis, while the secondary outcome was the metabolic efficacy of BS in this group postoperatively. Results A total of 47 patients met the study criteria, including 46 cases of Child-Pugh class A cirrhosis and 1 case of Child-Pugh B. Pathological examination confirmed nodular cirrhosis in 21 patients (44.68%), pseudolobule formation in 1 patient (2.13%), lipedema degeneration with inflammatory cell infiltration in 3 patients (6.38%), and chronic hepatitis in 1 patient (2.13%). The average percentage of total weight loss was 29.73 ± 6.53% at one year postoperatively. During the 30-day postoperative period, the complication rate was 6.38%, which included portal vein thrombosis, gastrointestinal bleeding, and intra-abdominal infection. Moreover, no cases of liver decompensation or mortality were reported during the follow-up period. The remission rates of comorbidities among 41 patients one year after surgery were as follows: dyslipidemia 100%, type 2 diabetes 82.61%, hypertension 84.62%, and obstructive sleep apnea syndrome 85.71%. Conclusions BS can be safely performed in patients with unexpected cirrhosis in the compensated stage of liver disease, with low postoperative morbidity and no mortality observed during one-year follow-up.
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Affiliation(s)
- Xia Sun
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Libin Yao
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xing Kang
- Department of Pancreatic and Metabolic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Weihua Yu
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Fidele Kakule Kitaghenda
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Mohammad Sajjad Ibn Rashid
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Angeline Nogue Taguemkam
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jian Hong
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zhiyong Dong
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Xitai Sun
- Department of Pancreatic and Metabolic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Xiaocheng Zhu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
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Al Wadaani HA, Al Omar S, AlRaihan J, Alnajjar JS, Elserougi M, Al Jabran H. Post laparoscopic sleeve gastrectomy portal vein thrombosis with venous mesenteric ischemia: a case report with literature review. J Surg Case Rep 2024; 2024:rjae462. [PMID: 39171196 PMCID: PMC11338332 DOI: 10.1093/jscr/rjae462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 07/07/2024] [Indexed: 08/23/2024] Open
Abstract
Saudi Arabia's obesity prevalence is 19.2% among men and 21.4% among women. Treatment includes lifestyle modifications, medication, and bariatric surgery. Procedures reach up to 1200 annually in our center. Porto-mesenteric venous thrombosis associated with venous mesenteric ischemia and bowel necrosis is a rare complication that necessitates an early workup and management. A 29-year-old Saudi male underwent laparoscopic sleeve gastrectomy. Post-surgery, he experienced abdominal pain, nausea, and vomiting, exacerbated by eating and smoking. Abdomen computed tomography scans revealed engorged portal veins, congested mesenteric veins, and small bowel thickening. He underwent exploratory laparoscopy shifted to laparotomy with resection of an infarcted omentum and 1 m of jejunal small bowel loop, and was discharged postoperatively after 7 days. Porto-mesenteric venous thrombosis is a rare complication after laparoscopic sleeve gastrectomy, requiring early diagnosis and appropriate treatment. Patients present with non-specific symptoms, necessitating high suspicion for computed tomography recommendations.
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Affiliation(s)
| | - Sarah Al Omar
- College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia
| | - Jawaher AlRaihan
- College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia
| | - Jawad S Alnajjar
- College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia
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Belluzzi A, Sample JW, Marrero K, Tomey D, Puvvadi S, Sharma I, Ghanem OM. Rare Complications Following Laparoscopic Sleeve Gastrectomy. J Clin Med 2024; 13:4456. [PMID: 39124722 PMCID: PMC11313060 DOI: 10.3390/jcm13154456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 07/26/2024] [Accepted: 07/27/2024] [Indexed: 08/12/2024] Open
Abstract
Metabolic and bariatric surgery (MBS) is the most effective and durable therapeutic intervention for patients with obesity. In recent years, laparoscopic sleeve gastrectomy (SG) has become the most commonly performed primary MBS procedure owing to its technical feasibility and excellent short-term outcomes. Despite these favorable results and perceived advantages, SG is associated with several unique complications. Complications such as a postoperative leak or bleeding have been more commonly observed and reported than others, and their management approaches are well described. However, other complications following SG are far less familiar to surgeons, which may delay recognition and result in poor patient outcomes. Of these complications, we describe splenic injuries; esophageal perforation; staple line malformations; stapling of intraluminal devices; phytobezoar formation; gastro-colic, gastro-pleural and gastro-bronchial fistula; pancreatic leak; and portomesenteric venous thrombosis. It is paramount for surgeons to be aware of these underreported issues and have the resources to learn how to recognize and manage them when they arise. This review aims to describe rare (i.e., reported incidence <1%) and underdescribed complications after SG, focusing on causes, clinical presentation, prevention strategies, and management.
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Affiliation(s)
- Amanda Belluzzi
- Department of Surgery, Mayo Clinic, Rochester, MN 55095, USA; (A.B.); (J.W.S.)
- Department of Surgery, Rovigo Hospital, 45100 Rovigo, Italy
| | - Jack W. Sample
- Department of Surgery, Mayo Clinic, Rochester, MN 55095, USA; (A.B.); (J.W.S.)
| | - Katie Marrero
- Carle Foundation Hospital General Surgery Residency, Champaign, IL 61801, USA
| | - Daniel Tomey
- Department of General Surgery, Houston Methodist Hospital, Houston, TX 77030, USA;
| | - Suraj Puvvadi
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA
| | - Ishna Sharma
- St. Peter’s Health Partners Bariatric and Metabolic Care, Albany, NY 12208, USA;
| | - Omar M. Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN 55095, USA; (A.B.); (J.W.S.)
- Division of Metabolic and Abdominal Wall Reconstructive Surgery, Mayo Clinic, Rochester, MN 55095, USA
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Gomes R, Costa-Pinho A, Ramalho-Vasconcelos F, Sousa-Pinto B, Santos-Sousa H, Resende F, Preto J, Lima-da-Costa E, CRI-O Group. Portomesenteric Venous Thrombosis after Bariatric Surgery: A Case Series and Systematic Review Comparing LSG and LRYGB. J Pers Med 2024; 14:722. [PMID: 39063976 PMCID: PMC11277930 DOI: 10.3390/jpm14070722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 06/25/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
(1) Background: Portomesenteric Venous Thrombosis (PMVT) is a rare but serious complication of Metabolic Bariatric Surgery (MBS). Although more frequently reported after laparoscopic sleeve gastrectomy (LSG), the risk factors for PMVT remain unclear. This study aims to compare the incidence and determinants of PMVT between LSG and laparoscopic Roux-en-Y gastric bypass (LRYGB). (2) Methods: A retrospective analysis of 5235 MBSs conducted at our institution between 2015 and 2023 identified five cases of PMVT. Additionally, a systematic review in March 2023, covering PubMed, Web of Science and Scopus, was performed. Several data were analyzed regarding risk factors. (3) Results: In our case series, the incidence of PMVT was 0.1%. The five cases described involved four females with a BMI between 39.7 and 56.0 kg/m2. Their comorbidities were associated with metabolic syndrome, all women used oral contraceptive and two patients were diagnosed with thrombophilia or pulmonary embolism. Per protocol, thromboprophylaxis was administered to all patients. Diagnosis was made at a median of 16 days post-surgery, with abdominal pain being the main presenting symptom. Acute cases were managed with enoxaparin, unfractionated heparin and fibrinolysis. One patient required surgery. Ten studies were included in the systematic review and 205 patients with PMVT were identified: 193 (94.1%) post-LSG and 12 post-LRYGB. The most common comorbidities were dyslipidemia, hypertension, diabetes, sleep apnea and liver disorders; (4) Conclusions: PMVT is a potentially life-threatening complication after MBS, requiring preventive measures, timely diagnosis and several treatments. Our findings suggest a higher occurrence in women with an elevated BMI and post-LSG. Tailored thromboprophylaxis for MBS patients at risk of PMVT may be warranted.
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Affiliation(s)
- Raquel Gomes
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (R.G.)
| | - André Costa-Pinho
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (R.G.)
- Obesity Integrated Responsibility Unit (CRI-O), São João Local Health Unit, 4200-319 Porto, Portugal
| | | | - Bernardo Sousa-Pinto
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (R.G.)
- MEDCIDS—Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- CINTESIS—Centre for Health Technologies and Services Research, University of Porto, 4200-319 Porto, Portugal
| | - Hugo Santos-Sousa
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (R.G.)
- Obesity Integrated Responsibility Unit (CRI-O), São João Local Health Unit, 4200-319 Porto, Portugal
| | - Fernando Resende
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (R.G.)
- Obesity Integrated Responsibility Unit (CRI-O), São João Local Health Unit, 4200-319 Porto, Portugal
| | - John Preto
- Obesity Integrated Responsibility Unit (CRI-O), São João Local Health Unit, 4200-319 Porto, Portugal
| | - Eduardo Lima-da-Costa
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (R.G.)
- Obesity Integrated Responsibility Unit (CRI-O), São João Local Health Unit, 4200-319 Porto, Portugal
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Cuva D, Somoza E, Alade M, Saunders JK, Park J, Lipman J, Einersen P, Chui P, Parikh M. Routine extended (30 days) chemoprophylaxis for patients undergoing laparoscopic sleeve gastrectomy may reduce Portomesenteric vein thrombosis rates. Surg Obes Relat Dis 2024; 20:527-531. [PMID: 38195313 DOI: 10.1016/j.soard.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/25/2023] [Accepted: 12/06/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Venous thromboembolism (VTE), including Portomesenteric vein thrombosis (PMVT), is a major complication of sleeve gastrectomy (SG). We changed our practice in July 2021 to routinely discharge all SG patients postoperatively with extended chemoprophylaxis for 30 days. OBJECTIVES Evaluate the efficacy and safety of routine extended chemoprophylaxis compared to 2 prior timeframes using selective extended chemoprophylaxis. SETTING University Hospital. METHODS Between 2012-2018, SG patients were discharged on extended chemoprophylaxis for patients deemed "high-risk" for VTE, including patients with body mass index (BMI) >50, and previous VTE. Between 2018-2021, extended chemoprophylaxis was broadened to include patients with positive preoperative thrombophilia panels (including Factor VIII). After 2021, all SG were routinely discharged on extended chemoprophylaxis. The typical regimen was 30 days Lovenox BID (40-mg twice daily for BMI> 40, 60-mg twice daily for BMI >60). Outcomes evaluated were rate of VTE/PMVT and postoperative bleed, including delayed bleed. RESULTS A total of 8864 patients underwent SG. Average age and BMI were 37.5 years and 43.0 kg/m2, respectively. The overall incidence of PMVT was 33/8864 (.37%). Converting from selective extended chemoprophylaxis (Group 1) to routine extended chemoprophylaxis (Group 3) decreased the rate of PMVT from .55% to .21% (P = .13). There was a significantly higher overall bleeding rate (.85%), including delayed bleeds (.34%) in the routine extended chemoprophylaxis patients (P < .05). These bleeds were mainly managed nonoperatively. CONCLUSIONS Routine extended (30 day) chemoprophylaxis for all SG may reduce PMVT rate but lead to a higher bleeding rate post-operatively. The vast majority of the increased bleeds are delayed and can be managed non-operatively.
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Affiliation(s)
- Dylan Cuva
- Department of Surgery, NYU Langone Medical Center, Bellevue Hospital Center, New York, New York.
| | - Eduardo Somoza
- Department of Surgery, NYU Langone Medical Center, Bellevue Hospital Center, New York, New York
| | - Moyosore Alade
- Department of Surgery, NYU Langone Medical Center, Bellevue Hospital Center, New York, New York
| | - John K Saunders
- Department of Surgery, NYU Langone Medical Center, Bellevue Hospital Center, New York, New York
| | - Julia Park
- Department of Surgery, NYU Langone Medical Center, Bellevue Hospital Center, New York, New York
| | - Jeffrey Lipman
- Department of Surgery, NYU Langone Medical Center, Bellevue Hospital Center, New York, New York
| | - Peter Einersen
- Department of Surgery, NYU Langone Medical Center, Bellevue Hospital Center, New York, New York
| | - Patricia Chui
- Department of Surgery, NYU Langone Medical Center, Bellevue Hospital Center, New York, New York
| | - Manish Parikh
- Department of Surgery, NYU Langone Medical Center, Bellevue Hospital Center, New York, New York
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