Not All Leaks Are Created Equal: a Comparison Between Leaks After Sleeve Gastrectomy and Roux-En-Y Gastric Bypass

Wang

et al. 2022

Preprint

Background Gastroduodenal anastomotic leakage is one of the most dreadful complications of gastrectomy and poses a great threat for treatment. However, there has been no effective treatment for it up to now. We report a case, a patient with huge gastroduodenal anastomotic leakage, was eventually recovered after conservative treatment up front and later resolution of anastomotic obstruction through gastrojejunostomy and jejunostomy. Case presentation: A 50-year-old man underwent a distal gastrectomy for a giant penetrating ulcer in the lesser curvature of the gastric sinus. Digestive reconstruction was completed by the Billroth I method. But an anastomotic leakage occurred on postoperative day 9 and a high output of duodenal juice was observed, and the following gastroscopy suggested that there was a large breach in the gastroduodenal anastomosis. Because of the patency of the drainage tube and the limitations of the patient's condition, conservative treatment was advocated and a nasojejunal tube was placed under the gastroscope for enteral nutrition. Unexpectedly, during subsequent treatment, persistent hypothermia associated with rheumatoid arthritis, drainage-associated transverse colon leakage and anastomotic stenosis occurred. Eventually, after taking the gastrojejunostomy and jejunostomy and gradually withdrawing and flushing the drainage tube, the patient was able to achieve a tube-free state and eat in the normal way. Conclusions The course of the patient’s treatment was continuous and systematic. In this case, we found that conservative treatment was feasible for giant gastroduodenal anastomotic leakage in the presence of patent drainage and limited physical signs. And for secondary anastomotic stenosis, gastrojejunostomy can effectively relieve the obstruction.

Section: Discussionmentioning

confidence: 99%

Systematic treatment of giant gastroduodenal anastomotic leakage：a case report

Wang

et al. 2022

Preprint

“…21 It is of concern because leakage after sleeve gastrectomy is much more difficult to manage than leakage after RYGB. 22 Our main concern is about stenosis in this restrictive procedure. RYGB did not prevent one death from esophageal adenocarcinoma treated by the Lewis-Santy procedure and one Barett's esophagus under surveillance.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Complications of Open Mason's Vertical Banded Gastroplasty at a Single Tertiary Center and Literature Review

Greilsamer

Jacobi

Krempf

et al. 2019

The American Surgeon

Vertical banded gastroplasty (VBG), introduced by Mason in 1982, is now discarded because of important long-term complications and technical difficulties to do revisional surgery. We investigated the long-term complications of VBG in our center and compared it with the literature data. Patients who underwent an open VBG at the University Hospital of Nantes between October 1991 and May 2006 were included. We reviewed preoperative clinical data, long-term outcome in weight loss, complications, and revisional surgeries with a long follow-up. Sixty-three patients (52 women and 11 men) were included, with a mean age of 43 ± 10 years and a body mass index of 46.7 ± 8.3 kg/m. The mean follow-up was 8.2 ± 4.2 years. At the end of follow-up, the mean excess weight loss (EWL) was 29.8%. Long-term success (excess weight loss > 50%) of the procedure was observed in 25 patients (39.7%). A second intervention was performed in 15 patients (23.8%), and three needed a third redo procedure. Six patients (40%) had this new intervention for late complications, and nine (60%) for weight regain. Weight loss is satisfying in the long term although the rate of reintervention is high. Long-term complication can be severe, especially with gastric stenosis that could lead to esophageal cancer. A second reintervention could be technically demanding, especially by laparoscopy, and the patients should be referred to a specialized center.

“…[124][125][126] In addition, GL treatment through endoscopic internal drainage coupled to prompt external drainage mobilization is controversial. [127][128][129] Compared with other treatments, the management of leaks following LSG is more difficult and usually need endoscopic therapies. 129 The two probable explanations are as follows: the mechanism of SG, specifically the creation of a high-pressure gastric tube associated often with a functional angular stenosis, and lack of standardization in the management of the fistula, particularly when an endoscopic approach is used.…”

Section: Revisional Surgeries For Gastric Leakmentioning

confidence: 99%

“…[127][128][129] Compared with other treatments, the management of leaks following LSG is more difficult and usually need endoscopic therapies. 129 The two probable explanations are as follows: the mechanism of SG, specifically the creation of a high-pressure gastric tube associated often with a functional angular stenosis, and lack of standardization in the management of the fistula, particularly when an endoscopic approach is used. 130 Revisional bariatric surgery is usually suitable for patients with chronic leaks, which is hard to treat through endoscopic treatment.…”

Section: Revisional Surgeries For Gastric Leakmentioning

confidence: 99%

Revisional Surgeries of Laparoscopic Sleeve Gastrectomy

Li¹,

Jiao²,

Zhang³

et al. 2021

DMSO

Bariatric surgery has become increasingly common due to the worldwide obesity epidemic. A shift from open to laparoscopic surgery, specifically, laparoscopic sleeve gastrectomy (LSG), has occurred in the last two decades because of the low morbidity and mortality rates of LSG. Although LSG is a promising treatment option for patients with morbid obesity due to restrictive and endocrine mechanisms, it requires modifications for a subset of patients because of weight regain and tough complications, such as gastroesophageal reflux, strictures, gastric leak, and persistent metabolic syndrome., Revision surgeries have become more and more indispensable in bariatric surgery, accounting for 7.4% in 2016. Mainstream revisional bariatric surgeries after LSG include Roux-en-Y gastric bypass, repeated sleeve gastrectomy, biliopancreatic diversion, duodenal switch, duodenal-jejunal bypass, one-anastomosis gastric bypass, single anastomosis duodeno-ileal bypass (SAID) and transit bipartition. This review mainly describes the revisional surgeries of LSG, including the indication, choice of surgical method, and subsequent effect.