Case report about the management of a late Gastro-Gastric Fistula after Laparoscopic Gastric Bypass, with the finding of an unexpected foreign body

Rizk, Simon; Moussa, Wissam El Hajj; Assaker, Nidal; Makhoul, Elias; Chelala, E.

doi:10.1016/j.ijscr.2020.01.012

Cited by 8 publications

(9 citation statements)

References 16 publications

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“…[ 11 ] Although excluded from the analysis, it is important to note that none of these GastriSaiL TM bougie entrapments have been reported in the medical literature. Nine articles provided data to analyze; 6 were anecdotal case reports [ 2 , 3 , 5 – 7 , 9 ] and 3 were case series including a national survey from Israel [ 4 ] and 2 retrospective analyses reporting on consecutive series of patients [ 1 , 8 ] (Table 1 ). This limited dataset on 36 patients showed that; small-caliber OGT was the most commonly entrapped tube, stapling was the main reason of entrapment and SG was the most common causative operation.…”

Section: Resultsmentioning

confidence: 99%

“…The review identified 36 reported cases of iatrogenic stapling of an intraluminal tube during various bariatric procedures (i.e.,: SG, [ 2 , 4 , 6 , 8 ] Roux-en-Y gastric bypass (RYGB) [ 1 , 4 , 5 , 7 , 9 ] and duodenal switch [ 3 , 8 ] ). However, it also raised concern that such incidents are more common than reported as shown by the MAUDE data [ 11 ] and also noted by others [ 6 , 10 ] .…”

Section: Discussionmentioning

confidence: 99%

“…All 6 anecdotal reports addressed entrapped OGTs. Importantly, 3 reported intra-operatively overlooked entrapments requiring endoscopic removal [ 2 , 3 ] , emergency [ 2 ] or late [ 9 ] re-surgery. A stapled OGT remnant was found to be entrapped 3 years later at the blind part of the RYGB, during an assessment of a gastro-gastric fistula.…”

Section: Discussionmentioning

confidence: 99%

“…A stapled OGT remnant was found to be entrapped 3 years later at the blind part of the RYGB, during an assessment of a gastro-gastric fistula. [ 9 ] Surgical management strategy was similar in all, including the first case of a double entrapment recently reported. [ 7 ]…”

Section: Discussionmentioning

confidence: 99%

“…Surprisingly, not only OGTs [ 1 – 7 , 9 – 11 ] and temperature probes, [ 1 , 4 ] but also bougies [ 4 , 8 , 11 ] were stapled during bariatric procedures. The MAUDE data [ 11 ] commenting on 7 “unreported” bougie entrapments and the extreme morbidity associated with bougie entrapments in Baltasar et al series [ 8 ] is alarming.…”

Section: Discussionmentioning

confidence: 99%

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Inadvertent stapling of the orogastric tube during bariatric surgery

Çalıkoğlu¹,

Özgen²,

Yerdel³

2021

Medicine

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Background: Entrapment of an orally introduced tube by stapling/stitching is an intra-operative complication of bariatric surgery with grave consequences. Incidence is unknown. No prevention/management strategy is available. A systematic review was performed to assess the absolute reported observed risk and incidence. Additionally, data on 3 cases during our entire sleeve gastrectomy (SG) experience is evaluated. Methods: Literature is reviewed using PubMed/Web of science data-bases. Data was recorded prospectively. Videos of orally introduced tube staplings were re-watched, presentation/recognition/management were re-evaluated. A protocol ensuring the removal of the small caliber orogastric tube (OGT) by the surgeons direct inspection was introduced after the 3rd entrapment. Results: Review revealed OGT as the most commonly entrapped tube following temperature probe and bougie. SG/stapling were the most common causative operation/reason, respectively. Leak rates over 20%, conversion, early-late re-operations and mortality were reported. During our 948 consecutive SGs, 3 OGT entrapments (0.32%), third one with double stapling, occurred. All were recognized/managed intraoperatively by freeing the entrapped-end of the OGT from the sleeve part of the staple-line. In doubly stapled case, second transected end could only be recognized when routine reinforcement suturing come in proximity. Defects were continuously stitched with barbed suture. No morbidity occurred. One-year excess-weight-loss was 82%. A pre-protocol incidence of 0.56% (n: 3/534) dropped to nil in the remaining 414. Conclusion: Iatrogenic stapling of the OGT during SG is rare, but morbid. It must be avoided by a strict protocol. Upon occurrence/recognition, stapling must immediately stop until the “entirety” of the tube, including the “specimen-part”, is retrieved, to avoid double entrapment.

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