The usefulness and costs of routine contrast studies after laparoscopic sleeve gastrectomy for detecting staple line leaks

Terterov, D.; Leung, Philemon; Twells, Laurie; Gregory, Deborah M.; Smith, Chris; Boone, Darrell; Pace, D.

doi:10.1503/cjs.015216

Cited by 11 publications

(14 citation statements)

References 33 publications

(47 reference statements)

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“…As reported by literature, we found that the most common cause of traumatic esophageal perforation is due to a GSW, followed by SW and automobile accidents (car crash with injured motorcyclist and pedestrian injured by traffics) [[26], [27], [28], [29], [30]]. Concerning anatomic location, our findings are consistent with the scientific evidence, reporting cervical esophageal perforation as the most common type [18].…”

Section: Discussionsupporting

confidence: 90%

“…Concerning anatomic location, our findings are consistent with the scientific evidence, reporting cervical esophageal perforation as the most common type [18]. Cervical esophageal perforation has been described as less deleterious because the propagation of contamination is constrained in comparison with intrathoracic esophageal perforation [[27], [28], [29], [30]]. Cervical esophageal perforations have a lower mortality rate than thoracic and abdominal esophageal injuries.…”

Section: Discussionsupporting

confidence: 89%

“…An increase in morbidity and mortality is evident in intrathoracic perforation. Since the mucosa and gastroesophageal content will drain into the mediastinal cavity, it will lead to infections [[27], [28], [29], [30]]. We reported 6 thoracic esophageal cases, of which only 1 developed septic shock and another had an esophageal abscess.…”

Section: Discussionmentioning

confidence: 99%

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Traumatic esophageal perforation in Puerto Rico Trauma Hospital: A case-series

Vázquez-Rodríguez

Toro

García-Rodríguez

et al. 2019

Annals of Medicine and Surgery

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Background Esophageal injuries are rare, life-threatening, events with an overall reported incidence of less than 3%. In rare cases, trauma due to blunt or penetrating injuries cause esophageal perforations, which account for less than 15% of all esophageal injuries. Materials and methods A case-series study was conducted to describe the outcomes and management of all the traumatic esophageal injuries at the Puerto Rico Trauma Hospital (PRTH) from 2000 through 2017. These cases were evaluated in terms of etiology of perforation, mechanism of injury and esophageal level. Results Sixteen patients were treated for esophageal injuries at the PRTH between 2000 and 2017. Of these patients, 15 (93.7%) were males with a median age of 24.5 years (16, 49). Regarding the etiology of the esophageal perforation, 2 (12.5%) patients suffered blunt esophageal trauma, and 14 (87.5%) patients had penetrating trauma to the esophagus. The most common mechanism of perforation was gunshot wound 10 (62.4%), followed by stab wound 4 (25.0%), and the least common were motor vehicle collision 1 (6.3%) and pedestrian injured by traffic 1 (6.3%). Regarding esophageal location, 9 (56.3%) patients presented cervical, 6 (37.5%) thoracic, and 1 (6.3%) abdominal injuries. Most patients 13 (81.3%) had a prompt diagnosis of traumatic esophageal perforation, while 3 (18.7%) patients had a delayed diagnosis. Only 2 (12.5%) deaths occurred among our 16 patients, including 1 (6.3%) in delayed diagnosed subjects. Conclusion Esophageal perforation is a life-threatening condition and should be treated urgently. An early diagnosis and prompt surgical treatment completed in the first 24-h is fundamental for a good outcome.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 89%

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Traumatic esophageal perforation in Puerto Rico Trauma Hospital: A case-series

Vázquez-Rodríguez

Toro

García-Rodríguez

et al. 2019

Annals of Medicine and Surgery

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“…In addition, the needlessness and cost-ineffectiveness of RSG was demonstrated in other studies. For example, in a retrospective study published in 2017 and included 200 patients, three of all the gastrografin studies done came back positive and only one was proven to be a true positive [7]. Regarding hospital stay, a typical duration of 3 days was found regardless of whether or not the patient underwent RSG.…”

Section: Cost and Length Of Hospital Staymentioning

confidence: 99%

“…A contrast study that is performed by some surgeons in the first postoperative day for the early detection of such complications is routine post-sleeve gastrografin (RSG) study. It is still performed although several studies have concluded that it is needless considering that such complications are rare and CT scanning is an option that is more sensitive and easier to perform if, for example, leak is clinically suspected, such as when the post-operative patient presents with abdominal pain that is associated with fever and tachycardia or with septic shock [6,7].…”

Section: Introductionmentioning

confidence: 99%

Is routine post-sleeve gastrografin needed? Profile of 98 cases

et al. 2020

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Objective: Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed bariatric procedures. Some surgeons still perform routine post-sleeve gastrografin (RSG) study believing that it would detect post-LSG complications, especially leak. In this study, we aimed to evaluate the cost-effectiveness of RSG by considering the cost of the study, length of hospital stay and complications-related costs RSG could prevent. Results: A total of 98 eligible patients were included. Of them, 54 patients underwent RSG and 44 did not. Excluding the cost of LSG procedure, the average cost for those who underwent RSG and those who did not in Saudi Riyal (£) was 5193.15 (1054.77) and 4222.27 (857.58), respectively. The average length of stay (ALOS) was practically the same regardless of whether or not the patient underwent RSG. 90.8% (n = 89) of all patients stayed for 3 days. None of the patients developed postoperative bleeding, stenosis or leak. The mean weight, body mass index (BMI) and percentage weight loss (PWL) 6 months postoperatively were found to be 87.71 kg (SD = 17.51), 33.89 kg/m 2 (SD = 7.29) and 26.41% (SD = 9.79), respectively. The PWL 6 months postoperatively was 23.99% (SD = 8.47) for females and 30.57 (SD = 10.6) for males (p = 0.01).

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Laparoscopic Sleeve Gastrectomy: Technical Systematization for a Safe Procedure

Palermo

Cardoso

Gautier

2020

The Perfect Sleeve Gastrectomy

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Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure in the world, accounting for more than 50% of all bariatric procedures [1]. There are several factors that have led to its rapid traction since its inception. Firstly, in comparison to the laparoscopic adjustable gastric banding a gastric-restriction based procedure, which was still popular at that time, the sleeve was a simple, yet a powerful metabolic operation, activating significant hormonal pathways that lead to changes in eating behavior, glycemic control, and gut functions; all without the need for an implant and adjustments. Secondly, in contrast to Roux-en-Y gastric bypass (RYGB), LSG is less technically complex with no anastomosis. Being limited to the stomach makes it simpler and avoids the risk of internal hernias or other complications such as severe micronutrient and protein deficiency [45][46][47].In this chapter, we will describe the technical aspects of the LSG in order to perform the procedure safely and avoid simple errors that can occur.

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The usefulness and costs of routine contrast studies after laparoscopic sleeve gastrectomy for detecting staple line leaks

Cited by 11 publications

References 33 publications

Traumatic esophageal perforation in Puerto Rico Trauma Hospital: A case-series

Traumatic esophageal perforation in Puerto Rico Trauma Hospital: A case-series

Is routine post-sleeve gastrografin needed? Profile of 98 cases

Laparoscopic Sleeve Gastrectomy: Technical Systematization for a Safe Procedure

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