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Fukuya H, Iboshi Y, Wada M, Sumida Y, Harada N, Nakamuta M, Fujii H, Ihara E. Gastric cancer presenting with ramucirumab-related gastrocolic fistula successfully managed by colonic stenting: a case report. Clin Endosc 2023; 56:812-816. [PMID: 37165771 PMCID: PMC10665618 DOI: 10.5946/ce.2022.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/30/2022] [Accepted: 10/17/2022] [Indexed: 05/12/2023] Open
Abstract
We report a rare case of gastric cancer presenting with a gastrocolic fistula during ramucirumab and paclitaxel combination therapy that was successfully managed with colonic stenting. A 75-year-old man was admitted to our hospital with the chief complaint of melena. Esophagogastroduodenoscopy revealed a large ulcerated tumor in the lower stomach, judged by laparoscopy as unresectable (sT4bN1M0). After four cycles of first-line chemotherapy with S-1 plus oxaliplatin, the patient showed disease progression, and second-line therapy with ramucirumab and paclitaxel was started. At the end of the third cycle, the patient had gastric antral stenosis, which necessitated the placement of a gastroduodenal stent. When the patient complained of diarrhea 10 days later, esophagogastroduodenoscopy revealed a fistula between the greater curvature of the stomach and the transverse colon. The fistula was covered by double colonic stenting, with a covered metal stent placed within an uncovered metal stent, after which leakage from the stomach to the colon stopped.
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Affiliation(s)
- Hiroki Fukuya
- Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yoichiro Iboshi
- Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Masafumi Wada
- Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yorinobu Sumida
- Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Naohiko Harada
- Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Makoto Nakamuta
- Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
- Institute of Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Hiroyuki Fujii
- Department of Gastroenterology and Hepatology, National Hospital Organization Fukuoka Higashi Medical Center, Fukuoka, Japan
| | - Eikichi Ihara
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Kumaira Fonseca M, Coelho NHV, Manica JLL, Ramblo RR, Spier IE, Seabra AP. Endoscopic Management of a Chronic Gastrocutaneous Fistula after Bariatric Revisional Surgery Using a Novel Cardiac Septal Occluder. GE Port J Gastroenterol 2023; 30:52-56. [PMID: 37818401 PMCID: PMC10561307 DOI: 10.1159/000526507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/28/2022] [Indexed: 10/12/2023]
Abstract
Introduction Endoscopic techniques are now considered the first-line approach for the management of bariatric surgery-related fistulas. The off-label use of cardiac septal defect occluders (CSDO) is an emerging technique that has demonstrated favorable outcomes for the closure of extravascular defects, including gastrointestinal (GI) disruptions. Previous case reports have reported similar results with the CSDO Amplatzer™ for the management of GI disruptions following bariatric surgery. However, the use of similar alternative devices for this purpose has not yet been described. Case Presentation This case report presents the first reported use of the Occlutech® CSDO for the treatment of a chronic gastrocutaneous fistula after bariatric revisional surgery. Despite apparent initial success - no extravasation of contrast material through the device in the contrast study after the CSDO placement - fistula closure failed due to partial dislodgement of the device. The placement of a second device between the discs of the former one ultimately sealed the fistulous orifice. Discussion In chronic GI fistulas, the mature tract is often not liable to the application of standard endoscopic methods, leading to failed closure attempts. A new application of Occlutech® CSDO can obviate the clinical burden of a high-risk laparotomy in these cases. Appropriate endoscopic equipment as well as the involvement of a multidisciplinary team are prime conditions to ensure successful patient outcomes.
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Affiliation(s)
| | | | - João Luiz Langer Manica
- Interventional Cardiology in Congenital Heart Disease Department, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Rafael Ramos Ramblo
- Radiology and Diagnostic Imaging Department, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Ingrid Elisa Spier
- Critical Care and Internal Medicine Departments, Hospital Moinhos de Vento, Porto Alegre, Brazil
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Negm S, Mousa B, Shafiq A, Abozaid M, Allah EA, Attia A, AbdelKader T, Farag A. Endoscopic management of refractory leak and gastro-cutaneous fistula after laparoscopic sleeve gastrectomy: a randomized controlled trial. Surg Endosc 2023; 37:2173-2181. [PMID: 36326931 PMCID: PMC10017559 DOI: 10.1007/s00464-022-09748-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Gastro-cutaneous fistula is a rare complication after laparoscopic sleeve gastrectomy (LSG) with incidence of occurrence 1-2%. Most of gastro-cutaneous fistulae do not respond to conservative management and need intervention either surgically or endoscopically. METHODS This prospective randomized clinical study included referred patients who had LSG performed at our department or other centers, and complicated with post-LSG leak or gastro-cutaneous fistula between December/2019 and March/2021. Included patients were ASA Physical status I-II. Primary and secondary outcomes were recurrence of the fistula and mortality in each group after the intervention during the 18 months follow-up period, respectively. RESULTS Thirty patients were randomized into two groups: Surgery Group (SG, n = 15) and Endoscopy Group (EG, n = 15). Mean age of patients was 42.3 ± 8.7 and 42.6 ± 8.3 years-old in SG and EG, respectively. Females constituted 73.3% and 80% in SG and EG, respectively. Median time-to-gastric leak post LSG was six (range: 4-7) days in both groups. SG patients were surgically managed with primary repair of the gastric fistula and gastrojejunostomy in 13 patients or converting SG into Roux-en-Y gastric bypass in two patients, while EG patients were endoscopically managed with stitching, stenting, stenting and dilation, and clipping and dilation in 5, 4, 4 and 2 patients, respectively. Incidence of recurrent leak during 1st week was significantly higher in SG than EG (p < 0.001). No mortality reported in EG, while 2 patients died in SG (p = 0.48). CONCLUSION Endoscopic intervention may offer a successful modality in managing post-LSG gastric leak and gastro-cutaneous fistula that do not respond to conservative measures in stable patients.
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Affiliation(s)
- Said Negm
- grid.31451.320000 0001 2158 2757Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Bassam Mousa
- grid.31451.320000 0001 2158 2757Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Shafiq
- grid.31451.320000 0001 2158 2757Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed Abozaid
- grid.31451.320000 0001 2158 2757Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ehab Abd Allah
- grid.31451.320000 0001 2158 2757Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Adel Attia
- grid.31451.320000 0001 2158 2757Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Taha AbdelKader
- grid.415762.3Shepeen alkom teaching hospital, Ministry of health, Monufia, Egypt
| | - Ahmed Farag
- grid.31451.320000 0001 2158 2757Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Yzet C, Hakim S, Pioche M, Le Mouel JP, Deschepper C, Lafeuille P, Delcenserie R, Yzet T, Nguyen-Khac E, Fumery M, Brazier F. Endoscopic treatment of large gastric leaks after gastrectomy using the combination of double pigtail drains crossing a covered stent. Surg Endosc 2022; 36:9469-9475. [PMID: 36192655 DOI: 10.1007/s00464-022-09623-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/11/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Endoscopy is the gold standard for the treatment of postoperative gastric leaks (GL). Large fistulas are associated with high rate of treatment failure. The objective of this study was to assess the clinical efficacy of a combining technique using a covered stent (CS) crossing through pigtails (PDs) for large postsurgical GL leaks. METHODS All consecutive patients with large (> 10 mm) postsurgical GL treated endoscopically with a combination of a CS and PDs were included in a single-center retrospective study. The primary endpoint was the rate of GL closure. RESULTS A total of 29 patients were included. Twenty-five patients underwent sleeve gastrectomy. The fistula (median diameter 15 mm) was diagnosed 6 days (IQR 4-9) after surgery. Technical success was observed in all procedures. After a median follow-up of 10.7 months (IQR 3.8-20.7), GL closure was observed in 82.7% with a median time of 63 days (IQR 40-90). Surgical management was finally necessary in four patients after a median of 186 days (IQR 122-250). No complications related to combined endoscopic treatment were observed especially stent migration during the follow-up. CONCLUSION An endoscopic strategy combining CS crossing through PDs appears to be effective, safe and well tolerated for the treatment of large GL.
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Affiliation(s)
- Clara Yzet
- Gastroenterology Unit, Amiens University Hospital, Université de Picardie Jules Verne, Amiens, France.
| | - Sami Hakim
- Gastroenterology Unit, Amiens University Hospital, Université de Picardie Jules Verne, Amiens, France
| | - Mathieu Pioche
- Gastroenterology Unit, Hopital Edouard Herriot, Lyon, France
| | - Jean-Phillippe Le Mouel
- Gastroenterology Unit, Amiens University Hospital, Université de Picardie Jules Verne, Amiens, France
| | - Constance Deschepper
- Gastroenterology Unit, Amiens University Hospital, Université de Picardie Jules Verne, Amiens, France
| | | | - Richard Delcenserie
- Gastroenterology Unit, Amiens University Hospital, Université de Picardie Jules Verne, Amiens, France
| | - Thierry Yzet
- Radiology Unit, Amiens University Hospital, Université de Picardie Jules Verne, Amiens, France
| | - Eric Nguyen-Khac
- Gastroenterology Unit, Amiens University Hospital, Université de Picardie Jules Verne, Amiens, France
| | - Mathurin Fumery
- Gastroenterology Unit, Amiens University Hospital, Université de Picardie Jules Verne, Amiens, France
| | - Franck Brazier
- Gastroenterology Unit, Amiens University Hospital, Université de Picardie Jules Verne, Amiens, France
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Pavone G, Tartaglia N, Pacilli M, Maddalena F, Petruzzelli F, Ambrosi A. Leak after sleeve gastrectomy with positive intraoperative indocyanine green test: Avoidable scenario? Int J Surg Case Rep 2022; 95:107168. [PMID: 35567877 PMCID: PMC9111972 DOI: 10.1016/j.ijscr.2022.107168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/02/2022] [Accepted: 05/02/2022] [Indexed: 11/23/2022] Open
Abstract
Background The staple line gastric leak (GL) is estimated to be the most serious complication of the sleeve gastrectomy. The use of indocyanine green (ICG) has been introduced in minimally invasive surgery to show the vascularization of the stomach in real time and its application to the gastroesophageal junction (GE) during Laparoscopic Sleeve Gastrectomy (LSG) seems very promising. Case presentation We present the case of a 40-year-old female underwent laparoscopic sleeve gastrectomy. Intraoperative indocyanine green test showed a small dark area in the proximal third of the staple line reinforced with fibrin glue. Two weeks later the patient presented to the emergency room (ED) with abdominal pain, fever, vomiting, intolerance to oral intake and the evidence of a leak on the abdomen Computer Tomography (CT). The UIN for ClinicalTrial.gov Protocol Registration and Results System is: NCT05337644 for the Organization UFoggia. Conclusions This case report shows that intraoperative ICG test can be helpful in determining which patients are at greater risk of the leak and, more importantly, the cause of the leak but further tests are needed to determine if the ICG predicts leak due to ischemia. Fistulas after sleeve gastrectomy are complex and have multifactorial origins. Indocyanine Green (ICG) is a liquid that can be injected into the human bloodstream without adverse effects. This is a case report of a 40-year-old female with a positive intraoperative indocyanine green test as a prediction of the leak after sleeve gastrectomy.
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Affiliation(s)
- Giovanna Pavone
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122 Foggia, Italy.
| | - Nicola Tartaglia
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122 Foggia, Italy.
| | - Mario Pacilli
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122 Foggia, Italy.
| | - Francesca Maddalena
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122 Foggia, Italy
| | - Fabio Petruzzelli
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122 Foggia, Italy
| | - Antonio Ambrosi
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122 Foggia, Italy.
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Lock JF, Reimer S, Pietryga S, Jakubietz R, Flemming S, Meining A, Germer CT, Seyfried F. Managing esophagocutaneous fistula after secondary gastric pull-up: A case report. World J Gastroenterol 2021; 27:1841-1846. [PMID: 33967561 PMCID: PMC8072190 DOI: 10.3748/wjg.v27.i16.1841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/05/2021] [Accepted: 03/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastric pull-up (GPU) procedures may be complicated by leaks, fistulas, or stenoses. These complications are usually managed by endoscopy, but in extreme cases multidisciplinary management including reoperation may be necessary. Here, we report a combined endoscopic and surgical approach to manage a failed secondary GPU procedure.
CASE SUMMARY A 70-year-old male with treatment-refractory cervical esophagocutaneous fistula with stenotic remnant esophagus after secondary GPU was transferred to our tertiary hospital. Local and systemic infection originating from the infected fistula was resolved by endoscopy. Hence, elective esophageal reconstruction with free-jejunal interposition was performed with no subsequent adverse events.
CONCLUSION A multidisciplinary approach involving interventional endoscopists and surgeons successfully managed severe complications arising from a cervical esophago-cutaneous fistula after GPU. Endoscopic treatment may have lowered the perioperative risk to promote primary wound healing after free-jejunal graft interposition.
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Affiliation(s)
- Johan F Lock
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg 97080, Germany
| | - Stanislaus Reimer
- Department of Gastroenterology, University Hospital Würzburg, Würzburg 97080, Germany
| | - Sebastian Pietryga
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg 97080, Germany
| | - Rafael Jakubietz
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Würzburg, Würzburg 97080, Germany
| | - Sven Flemming
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg 97080, Germany
| | - Alexander Meining
- Department of Gastroenterology, University Hospital Würzburg, Würzburg 97080, Germany
| | - Christoph-Thomas Germer
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg 97080, Germany
| | - Florian Seyfried
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg 97080, Germany
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Rebibo L, Tricot M, Dembinski J, Dhahri A, Brazier F, Regimbeau JM. Gastric leak after sleeve gastrectomy: risk factors for poor evolution under conservative management. Surg Obes Relat Dis 2021; 17:947-955. [PMID: 33640258 DOI: 10.1016/j.soard.2021.01.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/16/2020] [Accepted: 01/21/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Gastric leak (GL) is the most highly feared early postoperative complication after sleeve gastrectomy (SG), with an incidence of 1% to 2%. This complication may require further surgery/endoscopy, with a risk of management failure that may require additional surgery, including total gastrectomy, leading to a risk of mortality of 0% to 9%. OBJECTIVES Assess the impact of factors that may lead to a poorer evolution of GL. SETTING University Hospital, France, public practice. METHODS This was a retrospective, single-center study of a group of patients managed for GL after SG between November 2004 and January 2019 (n = 166). Forty-three patients were excluded. The population study was divided into 2 groups: patients with easy closing of the GL (n = 73) and patients with difficult closing of the GL or failure to heal (n = 50). Patients were allocated to 1 of 2 groups depending on the time to heal (median time of 84 days). The study's primary efficacy endpoint was to determine the risk factors for a poorer evolution of GL. RESULTS Among 123 patients included in this study, 103 patients had undergone primary SG (83.7%). The mean time to the appearance of GL was 15.1 days (range, 1-156 d). Seventy-four patients underwent a reoperation (60%). The mean number of endoscopies per patient was 2.7 (range, 2-7 endoscopies). The mean time to healing was 89.5 days (range, 18-386 d). There were 8 cases of healing failure (6.5%). Multivariate analysis identified body mass index (>47 kg/m2), time to referral (>2 d), and serum prealbumin level (<.1 g/dL) to be independent risk factors for a poorer evolution of GL. CONCLUSION Improvement of nutritional status before SG and early referral for GL could reduce the risk of delayed closure or the need for further surgery.
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Affiliation(s)
- Lionel Rebibo
- Department of Digestive, Esogastric, and Bariatric Surgery, Bichat Claude Bernard University Hospital, Paris, France; Université de Paris, Inserm UMR 1149 F-75018 Paris, France
| | - Meghane Tricot
- Department of Digestive Surgery, Amiens University Medical Center, Amiens, France
| | - Jeanne Dembinski
- Department of Digestive Surgery, Amiens University Medical Center, Amiens, France
| | - Abdennaceur Dhahri
- Department of Digestive Surgery, Amiens University Medical Center, Amiens, France
| | - Franck Brazier
- Department of Hepato-Gastroenterology, Amiens University Medical Center, Amiens, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens University Medical Center, Amiens, France; Simplification of Surgical Patient Care Clinical Research Unit, University of Picardie Jules Verne, Amiens, France.
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Di Buono G, Buscemi S, Maienza E, Bonventre G, Romano G, Agrusa A. Splenic lymphoma with complex gastro-spleno-diaphragmatic fistula: 3D laparoscopic multivisceral resection. The first literature case report. Int J Surg Case Rep 2020; 77S:S8-S12. [PMID: 33191193 PMCID: PMC7876686 DOI: 10.1016/j.ijscr.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 10/03/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Gastrosplenic fistula is a rare disease involving stomach and spleen that can lead to dangerous complications like massive gastrointestinal bleeding. Diffuse large B-cell lymphoma (DLBC) is the principal pathological cause of gastrosplenic fistula. CASE REPORT We report a case of A 76-year-old caucasian woman came to the emergency room with fever for two week and gravative pain in left upper quadrant of the abdomen. CT scan of thorax and abdomen demonstrated an inhomogeneous hypodense large lymphomatous mass (10 × 6 cm) of upper pole of the spleen deformating medial profile and infiltrating gastric fundus and left diaphragm. with the diagnosis of complex gastro-splenic-diaphragmatic fistula we performed an en-block resection using a 3D laparoscopic vision system. DISCUSSION Gastrosplenic fistula is a rare complication of several clinical conditions. Among the different causes diffuse large B-cell lymphoma is the most frequent although diffuse histiocytic lymphoma, Hodgkin's lymphoma and extranodal NK/T-cell lymphoma are also described. After a literature review we found less then 30 cases of gastrosplenic fistula secondary to lymphoma. In our case report we do the first description of three-organs fistula envolvement, stomach, spleen and diaphragmatic dome, managed with 3D laparoscopic approach. CONCLUSION Gastrosplenic fistula can represent a fatal evolution of splenic or gastric lymphoma independently from chemotherapy treatment. The diagnosis of this condition is very difficult and related to its rarity. To our opinion, laparoscopy represents a valid and safe alternative to open surgery in management of these patients.
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Affiliation(s)
- Giuseppe Di Buono
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
| | - Salvatore Buscemi
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
| | - Elisa Maienza
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
| | - Giulia Bonventre
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
| | - Giorgio Romano
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
| | - Antonino Agrusa
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
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Palumbo D, Socci C, Martinenghi C, Guazzarotti G, Leone R, Nicoletti R, Rosati R, De Cobelli F. Leakage Risk Stratification After Laparoscopic Sleeve Gastrectomy (LSG): Is There a Role for Routine Postoperative CT Scan? Obes Surg 2020; 30:3370-3377. [PMID: 32291703 DOI: 10.1007/s11695-020-04586-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE Leakage of the gastric remnant after laparoscopic sleeve gastrectomy (LSG) represents an unpredictable, dreadful occurrence. Our aim was to assess whether routine postoperative CT scan is an effective tool for early prediction of leakage after LSG. MATERIALS AND METHODS From a prospectively acquired database, all consecutive patients who underwent LSG between January 2015 and December 2018 were identified; within this database, all patients who were evaluated with at least one contrast-enhanced CT scan within 48 h from surgery were enrolled in this retrospective study. The selected CT findings included twisting of the gastric remnant, perigastric air bubbles, and hematoma; the antral segment proximal from the pylorus to the first staple firing was also analyzed in terms of distance (StP, stapler to pylorus distance) and linearity (LI, linearity index). RESULTS After exclusions, 250 patients were included; 10 patients suffered from gastric leakage. Patients with perigastric hematoma and/or twisting of the distal part of the gastric remnant on routine postoperative CT scan were found to be more likely to develop leakage after LSG (p = 0.005 and p < 0.001, respectively). The mean StP was 45 ± 19.1 mm; the mean LI was 1.54 ± 0.4. Patients with subsequent development of leakage had significantly lower StP (26.7 ± 12.5 mm vs. 45.9 ± 18.9 mm; p = 0.001) and LI values (1.16 ± 0.11 vs. 1.55 ± 0.39; p = 0.002). CONCLUSION Routine postoperative CT scan after LSG permits early stratification of leakage risk, thus providing an actual aid for patients' management.
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Affiliation(s)
- Diego Palumbo
- Radiology Unit, San Raffaele Scientific Institute, San Raffaele Vita Salute University, via Olgettina 60, 20132, Milan, Italy. .,San Raffaele Vita Salute University, via Olgettina 60, 20132, Milan, Italy.
| | - Carlo Socci
- Metabolic, Bariatric and Transplant Surgery Unit, San Raffaele Scientific Institute, San Raffaele Vita Salute University, via Olgettina 60, 20132, Milan, Italy
| | - Carlo Martinenghi
- Radiology Unit, San Raffaele Scientific Institute, San Raffaele Vita Salute University, via Olgettina 60, 20132, Milan, Italy
| | - Giorgia Guazzarotti
- Radiology Unit, San Raffaele Scientific Institute, San Raffaele Vita Salute University, via Olgettina 60, 20132, Milan, Italy
| | - Riccardo Leone
- Radiology Unit, San Raffaele Scientific Institute, San Raffaele Vita Salute University, via Olgettina 60, 20132, Milan, Italy
| | - Roberto Nicoletti
- Radiology Unit, San Raffaele Scientific Institute, San Raffaele Vita Salute University, via Olgettina 60, 20132, Milan, Italy
| | - Riccardo Rosati
- San Raffaele Vita Salute University, via Olgettina 60, 20132, Milan, Italy.,GastroIntestinal Surgery Unit, San Raffaele Scientific Institute, San Raffaele Vita Salute University, via Olgettina 60, 20132, Milan, Italy
| | - Francesco De Cobelli
- Radiology Unit, San Raffaele Scientific Institute, San Raffaele Vita Salute University, via Olgettina 60, 20132, Milan, Italy.,San Raffaele Vita Salute University, via Olgettina 60, 20132, Milan, Italy
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Pilone V, Tramontano S, Renzulli M, Romano M, Monda A, Albanese A, Foletto M. Omentopexy with Glubran®2 for reducing complications after laparoscopic sleeve gastrectomy: results of a randomized controlled study. BMC Surg 2019; 19:56. [PMID: 31690312 PMCID: PMC6829794 DOI: 10.1186/s12893-019-0507-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 04/09/2019] [Indexed: 01/12/2023] Open
Abstract
Background Gastric fistulas, bleeding, and strictures are commonly reported after laparoscopic sleeve gastrectomy (LSG), that increase morbidity and hospital stay and may put the patient’s life at risk. We report our prospective evaluation of application of synthetic sealant, a modified cyanoacrylate (Glubran®2), on suture rime, associated with omentopexy, to identify results on LSG-related complications. Methods Patients were enrolled for LSG by two Bariatric Centers, with high-level activity volume. Intraoperative recorded parameters were: operative time, estimated intraoperative bleeding, conversion rate. We prospectively evaluated the presence of early complications after LSG during the follow up period. Overall complications were analyzed. Perioperative data and weight loss were also evaluated. A control group was identified for the study. Results Group A (treated with omentopexy with Glubran®2) included 96 cases. Control group included 90 consecutive patients. There were no differences among group in terms of age, sex and Body Mass Index (BMI). No patient was lost to follow-up for both groups. Overall complication rate was significantly reduced in Group A. Mean operative time and estimated bleeding did not differ from control group. We observed three postoperative leaks in Group B, while no case in Group A (not statistical significancy). We did not observe any mortality, neither reoperation. Weight loss of the cohort was similar among groups. In our series, no leaks occurred applying omentopexy with Glubran®2. Conclusion Our experience of omentopexy with a modified cyanoacrylate sealant may lead to a standardized and reproducible approach that can be safeguard for long LSG-suture rime. Trial registration Retrospective registration on clinicaltrials.gov PRS, with TRN NCT03833232 (14/02/2019).
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Affiliation(s)
- Vincenzo Pilone
- General, Bariatric and Emergency Surgery Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
| | - Salvatore Tramontano
- General, Bariatric and Emergency Surgery Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy.
| | - Michele Renzulli
- General, Bariatric and Emergency Surgery Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
| | - Mafalda Romano
- General, Bariatric and Emergency Surgery Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
| | - Angela Monda
- General, Bariatric and Emergency Surgery Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
| | - Alice Albanese
- Week Surgery Unit, University Hospital of Padova, Padova, Italy
| | - Mirto Foletto
- Week Surgery Unit, University Hospital of Padova, Padova, Italy
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11
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Kumar Sinha M, Mohakud S, Mishra TS, Barman A. An unusual presentation of gastric fistula following peptic perforation repair: A case report. Int J Surg Case Rep 2019; 56:29-31. [PMID: 30818159 PMCID: PMC6393669 DOI: 10.1016/j.ijscr.2019.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/14/2019] [Accepted: 01/23/2019] [Indexed: 12/03/2022] Open
Abstract
Late onset Gastrocutaneous fistulas are rare following the peptic perforation repair. A non-healing burst abdominal wound should be thoroughly investigated. It can be because of an underlying fistula. CT fistulogram is the investigation of choice to confirm the diagnosis. Operative intervention is difficult but the only method of cure in most of the circumstances.
Introduction Peptic perforation repair is a common stomach surgery. This surgery has not been associated with delayed onset gastrocutaneous fistula formation. However such a complication has been reported following a variety of other stomach surgeries. We are reporting this case as it is a rare complication. Also its diagnosis and management is challenging. Case summary We are presenting a case of peptic perforation repair where burst abdomen happened in the immediate post-operative period. The patient was put on conservative management. He responded well to it but his abdominal wound was not healing. After a wait of four months the wound was covered with a skin graft. The graft uptake was satisfactory but a discharging ulcer appeared on it. This condition persisted for one month. Finally a computed tomography Fistulogram (CT Fistulogram) was performed. It revealed an underlying complex gastric fistula. A repeat surgery was performed. Conclusion A gastrocutaneous fistula diagnosed at sixth month following the peptic perforation repair and causing minimal discomfort to the patient is a rare presentation. The abdominal wound following the surgery was possibly not healing because of the underlying fistula.
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Affiliation(s)
| | | | | | - Apurba Barman
- Department of Physical Medicine and Rehabilitation, AIIMS Bhubaneswar, India.
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12
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Yu J, Zhou CJ, Wang P, Wei SJ, He JS, Tang J. Endoscopic titanium clip closure of gastric fistula after splenectomy: A case report. World J Clin Cases 2018; 6:1047-1052. [PMID: 30568962 PMCID: PMC6288501 DOI: 10.12998/wjcc.v6.i15.1047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/08/2018] [Accepted: 11/15/2018] [Indexed: 02/05/2023] Open
Abstract
This report describes a 52-year-old male patient with blunt abdominal traumatic rupture of the spleen due to injuries sustained in an automobile accident. Following splenectomy, the patient developed a gastric fistula. He underwent a long period of conservative treatment, including antibiotics and total parenteral nutrition, which was ineffective. The fistula could not be closed and titanium clip closure using a gastroscopy was then performed in order to close the fistula. After endoscopic therapy and clipping surgery, the patient’s general condition improved significantly, and he had no post-procedural abdominal complications. On post-clipping day 6, the gastric fistula was completely closed as shown by X-ray examination of the upper digestive tract. The patient was discharged from hospital and no complications were observed during the six-month follow-up period. Our report suggests that titanium clip closure using endoscopy may be the choice of treatment in patients with a gastric fistula.
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Affiliation(s)
- Jing Yu
- Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
- Sichuan Key Laboratory of Medical Imaging, Nanchong 637000, Sichuan Province, China
| | - Cheng-Ji Zhou
- Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
- Sichuan Key Laboratory of Medical Imaging, Nanchong 637000, Sichuan Province, China
| | - Pan Wang
- Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
- Sichuan Key Laboratory of Medical Imaging, Nanchong 637000, Sichuan Province, China
| | - Shou-Jiang Wei
- Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Jin-Song He
- Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Jin Tang
- Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
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13
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Phen C, Wilsey A, Swan E, Falconer V, Summers L, Wilsey M. Non-Surgical Management of Gastroduodenal Fistula Caused by Ingested Neodymium Magnets. Pediatr Gastroenterol Hepatol Nutr 2018; 21:336-340. [PMID: 30345248 PMCID: PMC6182470 DOI: 10.5223/pghn.2018.21.4.336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 12/03/2017] [Accepted: 01/08/2018] [Indexed: 12/25/2022] Open
Abstract
Foreign body ingestions pose a significant health risk in children. Neodymium magnets are high-powered, rare-earth magnets that is a serious issue in the pediatric population due to their strong magnetic force and high rate of complications. When multiple magnets are ingested, there is potential for morbidity and mortality, including gastrointestinal fistula formation, obstruction, bleeding, perforation, and death. Many cases require surgical intervention for removal of the magnets and management of subsequent complications. However, we report a case of multiple magnet ingestion in a 19-month-old child complicated by gastroduodenal fistula that was successfully treated by endoscopic removal and supportive care avoiding the need for surgical intervention. At two-week follow-up, the child was asymptomatic and upper gastrointestinal series obtained six months later demonstrated resolution of the fistula.
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Affiliation(s)
- Claudia Phen
- Office of Medical Education, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States.,College of Arts and Sciences, Florida State University, Tallahassee, FL, United States
| | - Alexander Wilsey
- Office of Medical Education, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States.,College of Arts and Sciences, Florida State University, Tallahassee, FL, United States
| | - Emily Swan
- College of Arts and Sciences, Florida State University, Tallahassee, FL, United States
| | - Victoria Falconer
- College of Arts and Sciences, University of Florida, Gainesville, FL, United States
| | - Lisa Summers
- Pediatric Gastroenterology, Carolines Healthcare System, Charlotte, NC, United States
| | - Michael Wilsey
- Office of Medical Education, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States
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14
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Assalia A, Ilivitzki A, Ofer A, Suissa A, Manassa E, Khamaysi I, Mahajna A. Management of gastric fistula complicating laparoscopic sleeve gastrectomy with biological glue in a combined percutaneous and endoscopic approach. Surg Obes Relat Dis 2018; 14:1093-1098. [PMID: 29895427 DOI: 10.1016/j.soard.2018.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 03/31/2018] [Accepted: 04/15/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is considered as a first line treatment for morbid obesity around the globe. Leakage and subsequent gastric fistula is the most dreadful complication, which may lead to serious morbidity and even mortality. OBJECTIVES To assess the safety and efficacy of fibrin glue application in the setting of gastric fistula after LSG. SETTING University hospital, Israel. METHODS Twenty-four morbidly obese patients (mean age = 42.2 yr, mean body mass index = 42 kg/m2) developed gastric fistula after LSG. The fistula was acute in 10 patients, subacute in 9, and chronic in 5. Sixteen patients (67%) have had previous failed endoscopic interventions. Fibrin glue was applied percutaneously with fluoroscopic guidance, under endoscopic visualization. A pigtail drain was left in the distal tract to monitor and manage possible continuous leakage. RESULTS There were no complications except abdominal pain in 2 patients associated with fever in 1. Both resolved within 1 to 2 days. Fistula closure was achieved in all patients but 1 (95.8%). Closure was accomplished after a single application in 9 patients (39%), 2 applications in 8, 3 applications in 3, 5 applications in 2, and 6 applications in 1. All patients were followed with a mean time of 42.3 months (range, 20-46). CONCLUSIONS Although in most patients there was a need for multiple applications, our experience indicates that percutaneous fluoroscopic application of Fibrin glue under endoscopic visualization proved to be a simple, tolerable, and highly effective method for the treatment of selected patients with gastric fistula after LSG.
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Affiliation(s)
- Ahmad Assalia
- Department of General Surgery, Rambam Health Care Campus and the Rappaport faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
| | - Anat Ilivitzki
- Department of Radiology, Rambam Health Care Campus and the Rappaport faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Amos Ofer
- Department of Radiology, Rambam Health Care Campus and the Rappaport faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Alain Suissa
- Department of Gastroenterology, Rambam Health Care Campus and the Rappaport faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Elias Manassa
- Department of General Surgery, Rambam Health Care Campus and the Rappaport faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Iyad Khamaysi
- Department of Gastroenterology, Rambam Health Care Campus and the Rappaport faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Ahmad Mahajna
- Department of General Surgery, Rambam Health Care Campus and the Rappaport faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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15
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Aburajab MA, Max JB, Ona MA, Gupta K, Burch M, Michael Feiz F, Lo SK, Jamil LH. Covered Esophageal Stenting Is Effective for Symptomatic Gastric Lumen Narrowing and Related Complications Following Laparoscopic Sleeve Gastrectomy. Dig Dis Sci 2017; 62:3077-83. [PMID: 28815402 DOI: 10.1007/s10620-017-4701-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/27/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND STUDY AIMS Laparoscopic sleeve gastrectomy (LSG) is gaining popularity in treating morbid obesity. Prior studies showed a 3.5% risk of gastric sleeve stenosis (GSS). There is no consensus on how to treat these patients, and the role of endoscopic therapy has been addressed in only a few studies. We aim to assess the efficacy and safety of endoscopic stenting in the management of GSS following LSG. PATIENTS AND METHODS Retrospective data were reviewed from July 2009 to November 2013. Patients were referred for endoscopic therapy for symptoms or imaging findings suggestive of gastric leak or narrowing following LSG. Endoscopic therapy included the use of fully covered self-expanding esophageal metal stents (FCSEMS) in addition to over-the-scope clip system (OTSC) when necessary. RESULTS All 27 patients were females with mean age of 40 years; six patients were excluded from the study. Major symptom was nausea and vomiting in 57% of the patients. Five of 21 patients had concomitant leaks. All 21 patients underwent FCSEMS placement, and four out of five patients (80%) with concomitant leak had OTSC. The success rate in both groups for resolution of stricture and leak was 100%, and no surgical intervention was required. There were no immediate or delayed complications of endoscopic therapy. Median follow-up of 6 months was available for 20/21 patients. Among patients with gastric leak, 80% had resolution of their symptoms compared with 93% of patients with GSS. CONCLUSIONS Endoscopic therapy for LSG-related GSS or leaks with FCSEMS is highly effective and safe.
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16
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Saikaly E, Abi Fadel F, El Asmar A, El Rassi Z. Fundal herniation, strangulation, and fistulization to the left lung after greater curvature gastric plication. Clin Case Rep 2017; 5:394-398. [PMID: 28396754 PMCID: PMC5378854 DOI: 10.1002/ccr3.851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 08/11/2016] [Accepted: 01/15/2017] [Indexed: 11/30/2022] Open
Abstract
Gastric plication is not a complication‐free procedure. Herein, we present the first known case of gastric plication complicated by herniation of the gastric fundus into the chest cavity through the esophageal hiatus complicated by strangulation, necrosis, abscess formation, and communication between the gastric lumen and the left lung.
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Affiliation(s)
- Elias Saikaly
- Faculty of Medicine Saint George Hospital University Medical Center University of Balamand Beirut Lebanon
| | - Fahim Abi Fadel
- Faculty of Medicine Saint George Hospital University Medical Center University of Balamand Beirut Lebanon
| | - Antoine El Asmar
- Faculty of Medicine Saint George Hospital University Medical Center University of Balamand Beirut Lebanon
| | - Ziad El Rassi
- Faculty of Medicine Saint George Hospital University Medical Center University of Balamand Beirut Lebanon; General and digestive Surgery, Oncologic Surgery University of Balamand Beirut Lebanon
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17
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Lee KW, Kim HY, Kim CW, Kim YK, Kwon O, Kim MA, Cho Y, Yang K. Hepato gastric fistula as a rare complication of pyogenic liver abscess. Clin Mol Hepatol 2017; 23:87-90. [PMID: 28278560 PMCID: PMC5381831 DOI: 10.3350/cmh.2016.0029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/24/2016] [Accepted: 07/19/2016] [Indexed: 11/10/2022] Open
Abstract
Hepatogastric fistula following a pyogenic liver abscess is extremely rare, and only a handful of cases have been reported. An 88-year-old female presented with generalized weakness, fever and chills. An abdominal computed tomography scan revealed a 5cm-sized hypodense lesion with internal septa in the left lateral section of the liver. Due to initial suspicion of early liver abscess, she was treated with empirical intravenous antibiotics. Initially, aspiration or drainage of the liver abscess was not performed due to immature lesion characteristics. An ultrasonography-guided percutaneous drainage of the liver abscess was performed 17 days after hospitalization due to a more mature lesion appearance on follow-up imaging. On tubography, contrast media leakage through the fistulous tract was visualized. Surgical management was performed, and she was discharged 2 weeks after surgery.
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Affiliation(s)
- Kyu Won Lee
- Division of Hepatology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hee Yeon Kim
- Division of Hepatology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang Wook Kim
- Division of Hepatology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Ki Kim
- Division of Hepatology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ohbeom Kwon
- Division of Hepatology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min Ah Kim
- Division of Hepatology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youngyun Cho
- Division of Hepatology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Keungmo Yang
- Division of Hepatology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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18
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Garofalo F, Noreau-Nguyen M, Denis R, Atlas H, Garneau P, Pescarus R. Evolution of endoscopic treatment of sleeve gastrectomy leaks: from partially covered to long, fully covered stents. Surg Obes Relat Dis 2016; 13:925-932. [PMID: 28237561 DOI: 10.1016/j.soard.2016.12.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/05/2016] [Accepted: 12/16/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (SG) has become a widely accepted option in the treatment of morbid obesity. Gastric leaks after SG occur in .9%-2.2% of the patients, mostly at the gastroesophageal junction. The current treatment algorithm includes drainage, antibiotics, nutritional support, and endoluminal control. OBJECTIVES Our hypothesis is that long, fully covered stents represent a safe, effective solution for SG leaks. SETTING University hospital. METHODS A retrospective analysis of our prospectively collected bariatric database was performed between June 2014 and May 2016. We included all patients treated for leaks after SG. Endoscopic treatment included partially covered metallic stent (Wallstent, Boston Scientific, Galway, Ireland), fully covered stent (Mega stent, Taewoong Medical Industries, Gyeonggi-do, South Korea), over-the-scope clip (Ovesco Endoscopy, Tubingen, Germany), and internal pigtail drainage. RESULTS A total of 872 SGs were performed. Overall, 10 of 872 patients (1.1%) developed a gastric leak. One patient was an outside referral. The 11 patients underwent endoscopic treatment accompanied by either percutaneous or laparoscopic abscess drainage. Endoscopic fistula closure at the gastroesophageal junction was achieved in 10 of 11 cases and the average time for closure was 9.9 (range: 4-24) weeks. One patient developed a second leak in the antrum, treated by subtotal gastrectomy. Overall, treatment with Wallstent failed in 3 of 5 patients, and these patients were eventually successfully treated with a Mega stent. The initial use of long, fully covered stents was successful in 5 of 6 cases. CONCLUSION Long, fully covered stents appear to be a good alternative to traditional stents either as primary treatment or after failure of other endoscopic treatments.
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Affiliation(s)
- Fabio Garofalo
- Département de Chirurgie, Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| | - Maxime Noreau-Nguyen
- Département de Chirurgie, Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| | - Ronald Denis
- Département de Chirurgie, Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| | - Henri Atlas
- Département de Chirurgie, Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| | - Pierre Garneau
- Département de Chirurgie, Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| | - Radu Pescarus
- Département de Chirurgie, Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada.
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19
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Rebibo L, Dhahri A, Regimbeau JM. Answer to letters of Vilallonga and Manenti on management of gastric fistula after sleeve gastrectomy. J Visc Surg 2015; 152:345-6. [PMID: 26483138 DOI: 10.1016/j.jviscsurg.2015.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- L Rebibo
- Service de chirurgie digestive, CHU d'Amiens, avenue René-Laennec, 80054 Amiens cedex 01, France
| | - A Dhahri
- Service de chirurgie digestive, CHU d'Amiens, avenue René-Laennec, 80054 Amiens cedex 01, France
| | - J-M Regimbeau
- Service de chirurgie digestive, CHU d'Amiens, avenue René-Laennec, 80054 Amiens cedex 01, France; EA4294, université de Picardie-Jules-Verne, 80054 Amiens cedex 01, France; Centre de recherche clinique, CHU d'Amiens, avenue René-Laennec, 80054 Amiens cedex 01, France.
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20
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Kotzampassi K, Stavrou G. Percutaneous endoscopic gastrostomy through the sinus tract of a surgical gastrostomy. Clin Endosc 2015; 48:78-80. [PMID: 25674532 PMCID: PMC4323439 DOI: 10.5946/ce.2015.48.1.78] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/03/2014] [Accepted: 01/13/2014] [Indexed: 11/14/2022] Open
Abstract
We present the case of a woman on whom a percutaneous endoscopic gastrostomy (PEG) was performed through the sinus tract of a previous surgical gastrostomy for supraglottic obstructing malignancy. Five years after the induction of the surgical gastrostomy, she experienced a peristomal leakage, leading to severe necrotizing fasciitis, with skin irritation and inflammation. Despite extensive treatment to heal the abdominal wall close to the feeding tube, it recurred 3 months later, without any obvious cause. It was thus decided to perform a new gastrostomy in a nearby normal skin area, but, since it was totally impossible for the endoscope to be passed by mouth, due to obstruction, the sinus tract of the gastrostomy was used to facilitate endoscope insertion into the stomach for a new PEG.
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Affiliation(s)
| | - George Stavrou
- Department of Surgery, University of Thessaloniki, Thessaloniki, Greece
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21
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Liu SYW, Wong SKH, Ng EKW. Novel oesophago-gastro-duodenal stenting for gastric leaks after laparoscopic sleeve gastrectomy. Obes Res Clin Pract 2014; 9:214-9. [PMID: 25534492 DOI: 10.1016/j.orcp.2014.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 11/15/2014] [Accepted: 11/28/2014] [Indexed: 11/26/2022]
Abstract
The management of gastric leak after laparoscopic sleeve gastrectomy (LSG) can be complex and challenging. Whilst operative interventions are mostly complicated and reserved for unstable or refractory cases, endoscopic self-expandable metal stenting (SEMS) is increasingly preferred as a safer treatment option. Yet, SEMS carries the problems of frequent stent migration and inconsistent healing as ordinary SEMS is designed mainly for stenotic disease. We hereby present two cases of early and chronic post-LSG leakage that were respectively failed to be treated by surgery and ordinary SEMS but were successfully managed by a dedicated extra-long oesophago-gastro-duodenal stent. In oesophago-gastro-duodenal stenting, the characteristics of extra-long stent length allow total gastric exclusion between the mid-oesophagus and the first part of duodenum to prevent stent migration and to equalise high pressure gradient within the gastric sleeve to promote fistula healing.
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Affiliation(s)
- Shirley Yuk-Wah Liu
- Department of Surgery, Prince of Wales Hospital, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Simon Kin-Hung Wong
- Department of Surgery, Prince of Wales Hospital, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Enders Kwok-Wai Ng
- Department of Surgery, Prince of Wales Hospital, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China.
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22
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Abou Rached A, Basile M, El Masri H. Gastric leaks post sleeve gastrectomy: Review of its prevention and management. World J Gastroenterol 2014; 20:13904-13910. [PMID: 25320526 PMCID: PMC4194572 DOI: 10.3748/wjg.v20.i38.13904] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 05/21/2014] [Accepted: 06/17/2014] [Indexed: 02/06/2023] Open
Abstract
Gastric sleeve gastrectomy has become a frequent bariatric procedure. Its apparent simplicity hides a number of serious, sometimes fatal, complications. This is more important in the absence of an internationally adopted algorithm for the management of the leaks complicating this operation. The debates exist even regarding the definition of a leak, with several classification systems that can be used to predict the cause of the leak, and also to determine the treatment plan. Causes of leak are classified as mechanical, technical and ischemic causes. After defining the possible causes, authors went into suggesting a number of preventive measures to decrease the leak rate, including gentle handling of tissues, staple line reinforcement, larger bougie size and routine use of methylene blue test per operatively. In our review, we noticed that the most important clinical sign or symptom in patients with gastric leaks are fever and tachycardia, which mandate the use of an abdominal computed tomography, associated with an upper gastrointrstinal series and/or gastroscopy if no leak was detected. After diagnosis, the management of leak depends mainly on the clinical condition of the patient and the onset time of leak. It varies between prompt surgical intervention in unstable patients and conservative management in stable ones in whom leaks present lately. The management options include also endoscopic interventions with closure techniques or more commonly exclusion techniques with an endoprosthesis. The aim of this review was to highlight the causes and thus the prevention modalities and find a standardized algorithm to deal with gastric leaks post sleeve gastrectomy.
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Winata LSH, Kong CH, Thiruchelvam D. A case of a bleeding benign gastrocolic fistula in 2014. Int J Surg Case Rep 2014; 5:948-50. [PMID: 25460443 PMCID: PMC4275832 DOI: 10.1016/j.ijscr.2014.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 08/25/2014] [Accepted: 08/25/2014] [Indexed: 11/17/2022] Open
Abstract
The symptoms of gastrocolic fistulae are often undifferentiated. Barium enemas are the most accurate for diagnosis but gastroscopy should be performed to rule out malignancy. The mainstay of treatment of gastrocolic fistulae is surgical.
INTRODUCTION In the era of proton pump inhibitors in the treatment of peptic ulcer disease, the incidence of a gastrocolic fistula arising from unoperated gastric ulcers is extremely low. PRESENTATION OF CASE We present the case of a 68-year old farmer who presented with melaena and was found to have a benign gastrocolic fistula in the setting of untreated peptic ulcer disease, chronic NSAID ingestion and heavy alcohol intake. The diagnosis was made by gastroscopy. En bloc surgery was undertaken due to the size of the fistula and concomitant significant bleeding of the ulcer which would not have made it amenable to medical management. DISCUSSION The symptoms of a gastrocolic fistula are undifferentiated and the diagnosis can easily be missed in the setting of other complications such as bleeding or perforation of a hollow viscus. Barium enamas are the most accurate for the diagnosis but gastroscopy with biopsy is usually performed to rule out malignancy. The mainstay of treatment is usually surgical, though patients can be medically managed if he/she is not a surgical candidate. CONCLUSION Benign gastrocolic fistulas are rare and its diagnosis is easily missed.
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Affiliation(s)
- Leon Shin-Han Winata
- Upper Gastrointestinal Surgery, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Vic 3065, Australia.
| | - Cherng Huei Kong
- Upper Gastrointestinal Surgery, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Vic 3065, Australia
| | - Dhan Thiruchelvam
- Upper Gastrointestinal Surgery, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Vic 3065, Australia
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Rebibo L, Blot C, Verhaeghe P, Cosse C, Dhahri A, Regimbeau JM. Effect of perioperative management on short-term outcomes after sleeve gastrectomy: a 600-patient single-center cohort study. Surg Obes Relat Dis 2014; 10:853-8. [PMID: 24680761 DOI: 10.1016/j.soard.2013.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/02/2013] [Accepted: 12/26/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND Reports on the postoperative outcomes of sleeve gastrectomy (SG) have only been from small, single-center series and meta-analyses of studies with variable SG management. The objective of this study was to evaluate post-SG outcomes in a specialized bariatric surgery center with a routinely performed standardized procedure. METHODS The postoperative complication rate, operating times, and postoperative data were evaluated from all patients undergoing a primary SG between November 2004 and February 2012. Results were analyzed for 3 separate surgical periods, which differed with perioperative management. RESULTS Of 600 patients (mean age: 41.8±11.3; mean body mass index [BMI]: 47.2±16 kg/m²; 80% were women who underwent primary SG), 26.8% had a BMI≥50 kg/m². The mean operating time was 84 minutes. The rate of conversion was 1%. There were no postoperative deaths. The overall complication rate was 8.5%; the major complication rate was 5.6%; the revisional surgery rate was 4.6% and the gastric leak rate was 2.5%. Over the course of the 3 study periods, the operating time fell from 91±32 to 79±22 minutes (P≤.001); the length of hospital stay decreased from 4.5±4.9 to 3.4±4.3 days (P = .02); the major complication rate fell from 6.4% to 5.5% (P = NS); and the gastric fistula rate decreased from 4.6% to 1.9% (P = NS). CONCLUSION In a specialist bariatric surgery center, SG had an acceptable complication rate. Modifications in the perioperative management of SG were associated with a shorter mean operating time and hospital stay and did not increase the major complication or gastric fistula rates.
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Affiliation(s)
- Lionel Rebibo
- Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardie, Place Victor Pauchet, France
| | - Christelle Blot
- Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardie, Place Victor Pauchet, France
| | - Pierre Verhaeghe
- Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardie, Place Victor Pauchet, France
| | - Cyril Cosse
- Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardie, Place Victor Pauchet, France
| | - Abdennaceur Dhahri
- Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardie, Place Victor Pauchet, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardie, Place Victor Pauchet, France.
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