Treatments for Staple Line Leakage after Laparoscopic Sleeve Gastrectomy

Oshiro, Takashi; Wakamatsu, Kotaro; Nabekura, Taiki; Moriyama, Yuki; Kitahara, Natsumi; Kadoya, Kengo; Sato, Ayami; Kitahara, Tomoaki; Urita, Tasuku; Sato, Yu; Nagashima, Makoto; Tsuchiya, Masaharu; Okazumi, Shinichi

doi:10.3390/jcm12103495

Cited by 3 publications

(1 citation statement)

References 27 publications

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“…Although the rate of staple line leak in SG has dramatically decreased in the last decade being as low as 0.2% 22 , morbidly obese individuals with cACLD associated with CSPH represent a very selected subgroup of patients and their functional reserve to face a life-threatening complication as the staple line leak may be diminished. The treatment in case of staple line leak after SG normally consists as a first step in nil per OS and broad spectrum antibiotics administration; when this is not sufficient and a peritoneal abscess is identified, radiologic-guided drainage or laparoscopic drainage are performed 23 . However, no specific recommendations concerning how to manage this complication in patients with liver cirrhosis exists.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of bariatric surgery in the setting of compensated advanced chronic liver disease associated with clinically significant portal hypertension: a multicenter, retrospective, cohort study on feasibility and safety

Temime,

Ghanem,

Heimbach

et al. 2024

International Journal of Surgery

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Background: The obesity epidemic has led to an increase in the proportion of patients with chronic liver disease due to metabolic associated steatosic liver disease and in the prevalence of obesity in patients with cirrhosis. Metabolic and bariatric surgery has been proven to determine weight loss, obesity-related medical problems remission, and liver steatosis, inflammation, and fibrosis improvement. However, cirrhosis and portal hypertension are well-known risk factors for increased morbidity and mortality after surgery. The aim of this study is to evaluate the safety of metabolic and bariatric surgery in patients with compensated advanced chronic liver disease and clinically significant portal hypertension. Material and Methods: This is an international, multicentric, retrospective study on 63 individuals affected by obesity with compensated advanced chronic liver disease and clinically significant portal hypertension who underwent metabolic and bariatric surgery in tertiary referral centers with experts hepatobiliary surgeons between January 2010 and October 2022. The primary endpoint was post-operative mortality at 90 days. The secondary endpoints included postoperative weight loss at last follow-up and postoperative complication rate. In addition, we performed subgroup analyses of Child-Pugh (A vs. B) score, MELD (≤9 vs. >9) score and type of surgery. Results: One patient (1.6%) experienced gastric leakage and mortality. There were 3 (5%) reported cases of portal vein thrombosis, 2 (3%) postoperative acute renal failure, and 1 (1.6%) postoperative encephalopathy. Child-Pugh score A resulted to be a protective factor for intraoperative bleeding requiring transfusion at univariate analysis ((OR: 0.73, 95% CI: 0.55 – 0.97, P=0.046) but not at multivariate analysis. MELD>9 score and the type of surgery did not result to be a risk factor for any postoperative complication. Conclusion: Metabolic and bariatric surgery is safe in patients with compensated advanced chronic liver disease and clinically significant portal hypertension performed in tertiary bariatric referral centers with hepatobiliary expert surgeons. Larger, prospective studies with longer follow-up periods are needed to confirm these results.

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Section: Discussionmentioning

confidence: 99%

Outcomes of bariatric surgery in the setting of compensated advanced chronic liver disease associated with clinically significant portal hypertension: a multicenter, retrospective, cohort study on feasibility and safety

Temime,

Ghanem,

Heimbach

et al. 2024

International Journal of Surgery

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Long-Term Outcomes of Patients with Staple Line Leaks Following Sleeve Gastrectomy

Abu-Abeid,

Litmanovich,

Abu-Abeid

et al. 2024

OBES SURG

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Purpose The long-term outcomes of patients with staple line leaks (SLL) after SG are under-reported. The purpose of this study is to evaluate the long-term outcomes of patients with SLL after SG. Materials and Methods A retrospective analysis of a maintained patient registry of patients undergoing SG between January 2012 and December 2020 in a single bariatric center was analyzed and included patients with SLL. Outcomes were compared to a group without SLL. Results During this period, 1985 patients underwent SG of which 61 patients (3.1%) developed leak. 26 patients (1.3%) had overt SLL and the rest had organ space infection around the staple line. The mean age and body mass index (BMI) were 39.8 ± 11.3 and 41.5 ± 4.7, respectively. 7 patients (11.4%) underwent concomitant surgery and 12 patients (19.7%) had intraoperative complications. Leak was complicated by Clavien-Dindo ≥ 3 in 31 patients (50.8%). Reoperation rate was 27.8% (n = 17). ≥ 2 interventions were required in 26% of patients (n = 16). Two patients died during hospitalization due to septic complications. Long-term follow-up of median 121 months was available in 78% of the cohort (n = 48). The median total weight loss and BMI were 27% and 30.1 kg/m2, respectively. Weight loss outcomes were higher in comparison to patients without SLL. Seven patients (14.6%) underwent SG revision. All associated medical problems improved during follow-up except for gastroesophageal reflux which was found in 50% of cohort. Conclusion Long-term outcomes of SG patients with SLL are satisfactory in terms of weight loss, resolution of comorbidities, and requirement for surgical revision. Graphical Abstract

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New Endoscopic Devices and Techniques for the Management of Post-Sleeve Gastrectomy Fistula and Gastric Band Migration

Jung,

Binda,

Tuccillo

et al. 2024

JCM

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Post-sleeve gastrectomy fistulas are a rare but possibly severe life-threatening complication. Besides early reoperation and drainage, endoscopy is the main treatment option. According to the clinical setting, endoscopic treatment options comprise stent or clip placement. New endoscopic therapies have recently gained attention, including endoscopic vacuum therapy, VacStent therapy, endoscopic internal drainage with pigtail stents, endoscopic suturing and stem cell injection. In this narrative review, we shed light on recent literature, developments, indications and contraindications of these treatments. Intragastric gastric band migration is a rare complication after gastric band positioning. Reoperation can sometimes be difficult, especially when a gastric band has already migrated far into the stomach. Endoscopic retrieval can be a valid, non-invasive therapeutic solution. We reviewed the current literature on this matter.

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Treatments for Staple Line Leakage after Laparoscopic Sleeve Gastrectomy

Cited by 3 publications

References 27 publications

Outcomes of bariatric surgery in the setting of compensated advanced chronic liver disease associated with clinically significant portal hypertension: a multicenter, retrospective, cohort study on feasibility and safety

Outcomes of bariatric surgery in the setting of compensated advanced chronic liver disease associated with clinically significant portal hypertension: a multicenter, retrospective, cohort study on feasibility and safety

Long-Term Outcomes of Patients with Staple Line Leaks Following Sleeve Gastrectomy

New Endoscopic Devices and Techniques for the Management of Post-Sleeve Gastrectomy Fistula and Gastric Band Migration

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