Complications of staple line and anastomoses following laparoscopic bariatric surgery

Silecchia, Gianfranço; Iossa, Angelo

doi:10.20524/aog.2017.0201

Cited by 42 publications

(50 citation statements)

References 51 publications

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“…Silecchia and Iossa [9] reported that staplers with inappropriate firing and direct traumatic tissue injury are considered as "mechanical and tissular" causes, and the leakage normally occurs at 2 days post-surgery (early leak).…”

Section: Mechanical Aspectsmentioning

confidence: 99%

“…Moreover, they found that the optimal technical stapling time is 15 seconds before firing could be performed, thereby, allowing tissue compression and creeping and minimizing the excessive tensile stress [9].…”

Section: Mechanical Aspectsmentioning

confidence: 99%

“…Silecchia and Iossa [9] defined ischemic leaks as those occurring at 5 or 6 days postoperatively, and it was discovered that most leaks after LSG occur at the Angle of His. Consequently, most studies on ischemic leaks emphasized the need not to staple all of the tissues near the gastroesophageal junction (GEJ), keeping in mind the end goal of avoiding ischemic complications associated with the transection of the segmental vascularization in this area.…”

Section: Ischemic Aspectsmentioning

confidence: 99%

See 2 more Smart Citations

The Causes, Prevention, and Management of Gastric Leakage after Laparoscopic Sleeve Gastrectomy: A Review Article

Alanezi

Alshehri

Alrobiea

et al. 2019

J Metab Bariatr Surg

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Obesity has been considered a chronic relapsing disease. The increasing number of obese individuals has resulted in an increase in the demand for bariatric surgeries annually. Post-laparoscopic sleeve gastrectomy complications are challenging for both patients and surgeons. Thus, this paper reviews the most common and significant risk factors for leakage occurrence after laparoscopic sleeve gastrectomy and presents new tools, techniques, management options, and recommendations, gathered from newly published articles, for post-laparoscopic sleeve gastrectomy leakage. Causes of post-laparoscopic sleeve gastrectomy leakage include technical factors such as bougie size, transection point, reinforcement materials, and patient co-morbidities as well as ischemic reasons. Ischemic leakage, which is most commonly seen in laparoscopic sleeve gastrectomy, occurs usually after the fourth day, although some leakage may appear earlier within 1-3 days due to technical issues. Use of varied bougie sizes results in similar excess weight loss % at the one-year follow-up. Buttressing materials also reduce post-laparoscopic sleeve gastrectomy bleeding, but not the leakage rate. Endoscopic stents play a significant role in gastric leakage treatment in post-laparoscopic sleeve gastrectomy patients. Intra-operative or even early postoperative diagnostic tools can help in detecting early leaks, but minor leaks as well as those due to ischemic causes may be missed. In conclusion, laparoscopic sleeve gastrectomy is still one of the most effective bariatric surgeries, exhibiting approximately 70% excess weight loss. Although complications of post-laparoscopic sleeve gastrectomy are severe and may be life-threatening, most patients can be treated conservatively. However, those with persistent fistula require surgical intervention.

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Section: Mechanical Aspectsmentioning

confidence: 99%

Section: Mechanical Aspectsmentioning

confidence: 99%

Section: Ischemic Aspectsmentioning

confidence: 99%

See 1 more Smart Citation

The Causes, Prevention, and Management of Gastric Leakage after Laparoscopic Sleeve Gastrectomy: A Review Article

Alanezi

Alshehri

Alrobiea

et al. 2019

J Metab Bariatr Surg

View full text Add to dashboard Cite

show abstract

“…[ 30 ] After a few seconds of delay following jaws lock, the stapler gun should fire slowly. [ 3 31 32 33 ]…”

Section: How To Prevent Intraoperative Complicationsmentioning

confidence: 99%

“…In any case, the least invasive option must be tried because the anatomy is deteriorated, and tissues are not very suitable for an extensive procedure. [ 32 ]…”

Section: How To Prevent Intraoperative Complicationsmentioning

confidence: 99%

One-anastomosis gastric bypass as an alternative procedure of choice in morbidly obese patients

et al. 2018

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One-anastomosis gastric bypass is an attractive bariatric procedure. It is effective in weight loss and comorbidity resolution. It is a relatively simple and fast operation with low complication rates that make it a suitable option in super-obese individuals. Although not proven yet, there are some concerns about its long-term safety profile in terms of biliary reflux, marginal ulcer, and esophagogastric malignancy. In this article, we review the technique of this procedure and discuss about some practical surgical highlights. Furthermore, we overview studies performed about this procedure and compare it to some other well-established bariatric operations, while providing a detailed study about the facts related to its outcomes and complications.

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Meta‐analysis of patient risk factors associated with post‐bariatric surgery leak

Spiro

Bennet

Bhatia

2022

Obesity Science & Practice

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Objective Modifiable risk factors such as diabetes, hyperlipidemia, hypertension, obstructive sleep apnea (OSA), chronic kidney disease (CKD), chronic steroid use and smoking, have been shown in observational studies to negatively affect surgical outcomes. The purpose of this study is to identify and determine the effect of modifiable risk factors on post‐operative bariatric surgery leak, as pre‐operative risk modification has been shown to reduce the impact on complications. Methods Electronic literature searches of MEDLINE, PUBMED, OVID and Cochrane Library databases were performed, including a manual reference check, over the period of 2010 and 2020. 620 articles were screened according to the PRISMA protocol. Results Twenty articles were included in the meta‐analysis of risk factors. Significant risk factors and the associated effect sizes include: 1. Smoking with an overall OR of 1.31 [1.06, 1.61] and an OR of 1.72 [1.44, 2.05] in Sleeve gastrectomy (SG) patient cohorts; 2. Diabetes with an overall OR of 1.23 [1.08, 1.39] and an OR of 1.33 [1.02, 1.73] in Roux‐en‐Y patient cohorts; 3. Chronic kidney disease with an overall OR of 2.41 [1.62, 3.59] and 4. Steroid use with an overall OR of 1.57 [1.22, 2.02]. Non‐significant risk factors include hypertension with an OR of 0.85, 1.83, OSA with an OR of 1.08 [0.83, 1.39] and hyperlipidemia with an OR of 0.80 [0.61, 1.04]. Combined SG and Roux‐en‐Y patient cohorts with hyperlipidemia have shown a protective effect of 0.78 [0.65, 0.94]. Conclusions Significant risk factors for leak post bariatric surgery are smoking in all patients and particularly SG patients, diabetes for all patients and particularly Roux‐en‐Y patients, and CKD and chronic steroid for all patients. Hyperlipidemia in two combined patient cohorts (SG and Roux‐en‐Y) appears to have a weak protective effect.

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Complications of staple line and anastomoses following laparoscopic bariatric surgery

Cited by 42 publications

References 51 publications

The Causes, Prevention, and Management of Gastric Leakage after Laparoscopic Sleeve Gastrectomy: A Review Article

The Causes, Prevention, and Management of Gastric Leakage after Laparoscopic Sleeve Gastrectomy: A Review Article

One-anastomosis gastric bypass as an alternative procedure of choice in morbidly obese patients

Meta‐analysis of patient risk factors associated with post‐bariatric surgery leak

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