Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors

Iossa, Angelo; Abdelgawad, Mohamed; Watkins, Brad M.; Silecchia, Gianfranço

doi:10.1007/s00423-016-1464-6

Cited by 84 publications

(44 citation statements)

References 47 publications

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“…One of the most consequential complications of sleeve gastrectomy is leakage. Leakage from the staple line is the second most frequent cause of death associated with bariatric surgery 16 . The present study is the first to show that NCHA gel administration as a reinforcement agent increases crucial wound-healing parameters such as fibroblastic activity, neoangiogenesis, collagen deposition, and the tissue hydroxide protein level and reduces inflammatory reactions such as cell infiltration in the staple line after sleeve gastrectomy in rats.…”

Section: ■ Discussionmentioning

confidence: 99%

Effect of a new cross-linked hyaluronan gel on the staple line after sleeve gastrectomy in a rat model

Bülbüller

Karakaş²,

Yıldırım³

et al. 2018

Acta Cir. Bras.

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Section: ■ Discussionmentioning

confidence: 99%

Effect of a new cross-linked hyaluronan gel on the staple line after sleeve gastrectomy in a rat model

Bülbüller

Karakaş²,

Yıldırım³

et al. 2018

Acta Cir. Bras.

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“…Laparoscopic sleeve gastrectomy is at risk of resection line leaks in 1.1% to 6.5% of cases according to world literature [2–4]. In terms of pathogenesis, the leak is caused by a combination of: a) local factors – partial stomach wall ischemia, amount of stomach tissue caught in the staple, size of the staples, and staple failure, and b) general factors – metabolic disorders, abdominal obesity, etc.…”

Section: Discussionmentioning

confidence: 99%

Staple line leak with peritonitis after laparoscopic sleeve gastrectomy - a solution in one to six steps.

Špička¹

2017

Videosurgery and Other Miniinvasive Techniques

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IntroductionLaparoscopic sleeve gastrectomy (LSG) is one of the most efficient bariatric interventions in morbidly obese patients. The most severe risk of this procedure seems to be the staple line leak, and the management of this complication can be very arduous.AimTo share our experience in managing the staple line leak after LSG and to help to find the best procedure that should be preferred.Material and methodsIn the 2010–2015 period we performed 223 LSG, with about 5 demonstrating severe complications – two patients with severe bleeding requiring revision surgery, and three patients with resection surface leak.ResultsWe always primarily treated the staple line leak with a laparoscopic revision. Once the fistula did not spontaneously close after this treatment. A series of other methods were then indicated for this patient and only the sixth one resulted in the desirable therapeutic success. At first, our team opted for laparoscopic revision with drainage. The next procedure involved applying Ovesco and Boston clips. As a third method we performed abscess drainage through a nasobiliary tube inserted via gastroscopy. Due to failure we performed the second laparoscopic revision with staple line resuture, the next intervention was an open revision with fistula excision and suture, and finally we opted for the application of a self-expanding metallic stent, which proved to be definitely curative.ConclusionsWithout any guidelines it is very difficult to determine the right procedure addressing the staple line leak after LSG. It depends mainly on the clinician’s experience and is lengthy and often untraditional.

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“…During this procedure, we chose to focus on the 'Fundus Dissection' (Fig.2a). This surgical step is critical in the overall success of the procedure [15], and predicting its quality gives a good indicator of the overall quality of the surgery. Three distinct annotation datasets were manually created, and features were extracted from these annotations to obtain the input of our algorithm.…”

Section: Methodsmentioning

confidence: 99%

Predicting the quality of surgical exposure using spatial and procedural features from laparoscopic videos

et al. 2019

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Evaluating the quality of surgical procedures is a major concern in minimal invasive surgeries. We propose a bottom-up approach based on the study of Sleeve Gastrectomy procedures, for which we analyze what we assume to be an important indicator of the surgical expertise: the exposure of the surgical scene. We first aim at predicting this indicator with features extracted from the laparoscopic video feed. Second, to analyze how the extracted features describing the surgical practice influence this indicator. Method 29 patients underwent Sleeve Gastrectomy performed by two confirmed surgeons in a monocentric study. Features were extracted from spatial and procedural annotations of the videos, and an expert surgeon evaluated the quality of the surgical exposure at specific instants. The features were used as input of a classifier (linear discriminant analysis followed by a support vector machine) to predict the expertise indicator. Features selected in different configurations of the algorithm were compared to understand their relationships with the surgical exposure and the surgeon's practice. Results The optimized algorithm giving the best performance used spatial features as input (Acc = 0.68, Sn = 0.72, Sp = 0.7). It also predicted equally the two classes of the indicator, despite their strong imbalance. Analyzing the selection of input features in the algorithm allowed a comparison of different configurations of the algorithm and showed a link between the surgical exposure and the surgeon's practice.

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Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors

Cited by 84 publications

References 47 publications

Effect of a new cross-linked hyaluronan gel on the staple line after sleeve gastrectomy in a rat model

Effect of a new cross-linked hyaluronan gel on the staple line after sleeve gastrectomy in a rat model

Staple line leak with peritonitis after laparoscopic sleeve gastrectomy - a solution in one to six steps.

Predicting the quality of surgical exposure using spatial and procedural features from laparoscopic videos

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