Proximal Leakage After Laparoscopic Sleeve Gastrectomy: an Analysis of Preoperative and Operative Predictors on 1738 Consecutive Procedures

Cesana, Giovanni; Cioffi, Stefano Piero Bernardo; Giorgi, Riccardo; Villa, Roberta; Uccelli, Matteo; Ciccarese, Francesca; Castello, G; Scotto, Bruno; Olmi, Stefano

doi:10.1007/s11695-017-2907-z

Cited by 47 publications

(33 citation statements)

References 26 publications

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“…As mentioned in Tables 1 and 3, the patients who had a rise in Amylase values didn't differ from the patients who had normal Amylase values in preoperative variables including demographic data or medical background details, as mentioned in other studies [14,24], nor in surgery complications, surgery duration, peri-operative complications nor length of stay in the hospital.…”

Section: Discussionmentioning

confidence: 56%

Do high levels of Amylase following laparoscopic sleeve gastrectomy predict devastating complications?

Horn¹,

Assalia²,

Sayida³

et al. 2020

Preprint

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Background Gastric leak post laparoscopic sleeve gastrectomy (LSG) is a severe complication that may lead to sepsis and even to patient's death. Early diagnosis and treatment are critical. It was hypnotized that the appearance of high levels of amylase, especially in the drain, may indicate a leak from the gastric staple line. The purpose of this prospective study was to examine the incidence of Amylase increase in the blood, urine and drain fluid, after LSG and to examine whether the appearance of high levels of Amylase indicates the existence of a major complication and especially a leak from the staple line. Methods From 161 patients whom underwent Sleeve gastrectomy, we prospectively evaluated the demographic information, including Body-mass-index (BMI), comorbidities, complications during the surgery or hospitalization, laboratory data including complete blood count, liver function tests, glucose and Amylase levels in blood, urine and drain. Testing for the normal distribution of the variables was performed using Kolmogorov-Smirnov test. Based on the results of this test we performed T- test or Mann-Whitney test to find differences between groups. Multivariate analysis using logistic regression was performed to examine the independent variables which can predict a rise in Amylase values above the upper limit number (ULN). Results Of 161 patients in this study, 35 patients (21.8%) had a rise in the Amylase values in blood, urine and/or drain, and 126 patients (78.2%) had normal values of Amylase until discharge. Amylase rise has been found to be correlated with Neutrophilia (OR = 5.4, p = 0.003), indirect hyperbilirubinemia (OR = 3.9, p = 0.022) and a decline in phosphate level (OR = 2.48, p = 0.019). Furthermore, a rise in Amylase is significantly associated to a rise in Aspartate and Aspartate transaminase transaminases (AST and ALT), Gamma-Glutamyl Transferase (GGT), Creatine-phosphokinase (CPK), Glucose and leukocytes, and a decline in lymphocytes and Calcium. No significant change was found in the duration of the operation and neither in the length of hospitalization. No specific complication was found to be significantly higher in any of the groups. One patient suffered from staple line leak and was treated conservatively. The diagnosis was done in post- operative day three by abdominal CT-scan. The amylase levels in the blood and the drain were normal and only a slight increase of amylase in urine was measured. Conclusions Increase in Amylase after LSG doesn't necessarily indicate a major complication such as staple line leak and in the vast majority of cases, it seems to have no clinical relevancy. Therefore, it should not automatically lead to a full clinical investigation in the absence of further clinical signs. Our results suggest that there is no clinical justification for Amylase tests in any method after LSG.

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Section: Discussionmentioning

confidence: 56%

Do high levels of Amylase following laparoscopic sleeve gastrectomy predict devastating complications?

Horn¹,

Assalia²,

Sayida³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Shorter than a 2cm distance from pylorus was significantly associated with a high fistula incidence in univariate analysis. 9 On the other hand, Parikh et al couldn't detect an association between the proximity to pylorus and leakage. 10 In the same study, the leakage rate was lower when a bougie equal to or larger than 40F was used.…”

Section: Discussionmentioning

confidence: 98%

“…4,[6][7][8] Cesana et al, evaluated 1738 patients, detected leaks in 45 (2.6%) patients and reported no association between leaks and preoperative variables. 9 The operative variables which were detected to be associated with lower leak incidence included strengthening the staple line and the experience of surgeons. They reported that most of the leaks occurred in the first 100 cases of the surgeons which emphasized the importance of the learning curve.…”

Section: Discussionmentioning

confidence: 99%

Management of sleeve gastrectomy leakage with endoscopic stenting

Dogan

Dincer

2019

Int Surg J

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Background: Sleeve gastrectomy is one of the most commonly applied procedures for obesity surgery. Leakage from the stapler line and bleeding are the most important complications of sleeve gastrectomy. This study aimed to report the results of esophageal stent procedure applied to cases who developed leaks after sleeve gastrectomy.Methods: This study included patients who had sleeve gastrectomy due to morbid obesity and were detected to have a leak after the procedure. Demographic features, time of leakage after the surgery, and the management of the leak were analyzed.Results: it was detected in this study, 1220 cases who had sleeve gastrectomy for morbid obesity. Leaks were developed in 10 patients after Laparoscopic Sleeve Gastrectomy (LSG). Four patients, followed conservatively without stent application, were excluded. Six patients, treated with stent application, were included. Two of the patients were males, and four were females (M/F=1/2). The mean age was 38.3 (±11.57) (range: 26-58). The mean body mass index was 43.26 (±2.10)kg/m2. The incidence of a leak was 0.81%.Conclusions: In a conclusion, stents can be safely applied by experienced endoscopists for the management of sleeve gastrectomy leakage.

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“…The leak rates after sleeve gastrectomy were reported in various rates in the literature, but they are generally low. [8,10,11] Sleeve Gastrectomy Expert Panel Consensus Statement 2011, the leak rate was 1.06%. [12] Surgical intervention may be necessary in cases that cannot be conducted conservatively.…”

Section: Discussionmentioning

confidence: 99%

Indications of Reoperation After Sleeve Gastrectomy

Dogan¹

2019

Laparosc Endosc Surg Sci

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Introduction: Morbid obesity is a serious health condition. Surgical interventions play an essential role in treatment, and sleeve gastrectomy is one of the most widely performed bariatric surgical procedures. After bariatric surgery, some patients may require reoperation for several reasons, such as complications, cholelithiasis, and gastroesophageal reflux. This study is an examination of the indications for reoperation and the results observed in patients who underwent reoperation following sleeve gastrectomy. Materials and Methods: Patients who were reoperated on after sleeve gastrectomy for various reasons were analyzed retrospectively. The demographic characteristics, reoperation indications, surgical procedures, and results were analyzed. Results: Of a total of 1268 patients who underwent sleeve gastrectomy due to obesity, 15 who had a reoperation after laparoscopic sleeve gastrectomy were included in the study. The overall reoperation rate after sleeve gastrectomy was 1.18%. Cholelithiasis leak, hemorrhage, stenosis, intra-abdominal hematoma, and incisional hernia were identified as indications for reoperation. Conclusion: Reoperation for the patients who undergo bariatric surgery may be required for a number of reasons. The results of this study indicate that a second procedure after sleeve gastrectomy can be performed safely and with minimal risk.

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Proximal Leakage After Laparoscopic Sleeve Gastrectomy: an Analysis of Preoperative and Operative Predictors on 1738 Consecutive Procedures

Cited by 47 publications

References 26 publications

Do high levels of Amylase following laparoscopic sleeve gastrectomy predict devastating complications?

Do high levels of Amylase following laparoscopic sleeve gastrectomy predict devastating complications?

Management of sleeve gastrectomy leakage with endoscopic stenting

Indications of Reoperation After Sleeve Gastrectomy

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