EndoVAC therapy is a potentially useful adjunct to conventional treatments of a subset of upper gastrointestinal leaks and perforations when there is a contained cavity <8 cm. It appears less effective in an uncontained perforation or chronically established tract. It has clear advantages of being easily applied with readily available equipment and disposables.
Patients were older, heavier and suffered more co-morbid disease than previously reported cohorts. For the first time, excellent outcomes across a range of key quality domains in a large patient cohort have been reported in the public system. High-volume bariatric surgery in the public system is viable.
Objectives: To develop and validate a classification of sleeve gastrectomy leaks able to reliably predict outcomes, from protocolized computed tomography (CT) findings and readily available variables. Summary of Background Data: Leaks post sleeve gastrectomy remain morbid and resource-consuming. Incidence, treatments, and outcomes are variable, representing heterogeneity of the problem. A predictive tool available at presentation would aid management and predict outcomes. Methods: From a prospective database (2009-2018) we reviewed patients with staple line leaks. A Delphi process was undertaken on candidate variables (80-20). Correlations were performed to stratify 4 groupings based on outcomes (salvage resection, length of stay, and complications) and predictor variables. Training and validation cohorts were established by block randomization. Results: A 4-tiered classification was developed based on CT appearance and duration postsurgery. Interobserver agreement was high (k ¼ 0.85, P < 0.001). There were 59 patients, (training: 30, validation: 29). Age 42.5 AE 10.8 versus 38.9 AE 10.0 years (P ¼ 0.187); female 65.5% versus 80.0% (P ¼ 0.211), weight 127.4 AE 31.3 versus 141.0 AE 47.9 kg, (P ¼ 0.203). In the training group, there was a trend toward longer hospital stays as grading increased (I ¼ 10.5 d; II ¼ 24 d; III ¼ 66.5 d; IV ¼ 72 d; P ¼ 0.005). Risk of salvage resection increased (risk ratio grade 4 ¼ 9; P ¼ 0.043) as did complication severity (P ¼ 0.027).Findings were reproduced in the validation group: risk of salvage resection (P ¼ 0.007), hospital stay (P ¼ 0.001), complications (P ¼ 0.016).
Conclusion:We have developed and validated a classification system, based on protocolized CT imaging that predicts a step-wise increased risk of salvage resection, complication severity, and increased hospital stay. The system should aid patient management and facilitate comparisons of outcomes and efficacy of interventions.
Bowel perforation is a rare and unusual complication of laparoscopic adjustable gastric band (LAGB) insertion, which if left undiagnosed can have potentially fatal consequences. We present the first case ever published of a delayed presentation of small-bowel perforation secondary to a laparoscopic port insertion. A young woman presented to Emergency Department with intermittent vague abdominal pain for 5 months, on the background of having a LAGB inserted 4 years prior. She was subsequently found to have a small-bowel perforation with mesenteric adhesions to a laparoscopic port site. The patient underwent a successful small-bowel resection with primary anastomosis and made an uneventful recovery.
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