Superior and Inferior Gastric Pouch Dilatation Post-Sleeve Surgery: Does Revision Work? A Systematic Review and Case Reports

Abstract

Longitudinal sleeve gastrectomy (LSG) has become an acceptable option in the management of morbidly obese patients. Complications in the form of pouch dilatation may occur in post-sleeve surgery. However, revision sleeve gastrectomy procedures are effective in correcting such complications. The aim of this study was to systematically review all published cases that reported revision surgeries following the initial sleeve gastrectomy complicated by pouch dilatation. In addition, we are presenting two cases reported from our military/teaching hospital. A systematic literature search was conducted from English-language studies published from 2000 to 2014 from the following databases: PubMed, CINAHL, MEDLINE, EMBASE, Clinical evidence, Dara, Scopus, Web of Sciences, TRIP, Health Technology Database, Cochrane library, and Psych INFO. A total of 5340 articles were identified in the initial search and 5339 articles were excluded based on the exclusion criteria. Only one case study met the inclusion criteria for this systematic review, involving two patients. Also, we are reporting two cases with revision surgery performed for pouch dilatation post-sleeve surgery from our teaching hospital. There was only one study that reported revision surgery as a management of gastric pouch dilatation post-sleeve surgery. Authors believe * Corresponding author. K. Al Khalifa et al. 492 that the incidence of revision surgery for the management of pouch dilatation post-sleeve surgery is higher but underreported. This assumption may be valuable, especially because some surgeons consider pouch dilatation post-sleeve surgery a complication that arises due to surgical technique rather than the procedure itself; therefore, it is unreported.

Banded Sleeve Gastrectomy: Better Long-Term Results? A Long-Term Cohort Study Until 5 Years Follow-Up in Obese and Superobese Patients

“…The superior pouch dilation may occur because of an incomplete release of the posterior gastric fundus or preservation of a part of the fundus to avoid injury of the esophagogastric junction or when the last stapler is fired > 1 cm away from the gastroesophageal (GE) junction. On the other hand, an inferior pouch dilatation may rise due to antral preservation, which may occur due to the misplacement of the bougie or misidentification of the pylorus [ 16 ]. Another possibility for antrum dilation is when the stomach is resected > 4 cm distance from pylorus [ 17 ].…”