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Published in: Surgery Today 7/2014

01-07-2014 | Original Article

Results and complications after laparoscopic sleeve gastrectomy

Authors: Reinhard Mittermair, Robert Sucher, Alexander Perathoner

Published in: Surgery Today | Issue 7/2014

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Abstract

Purpose

Laparoscopic sleeve gastrectomy (SG) has gained popularity and acceptance among bariatric surgeons, mainly due its low morbidity and mortality. The purpose of the present study was to evaluate the efficacy of SG on weight loss, and to determine the postoperative course, clinical presentation and treatment of complications after SG.

Methods

Between January 2006 and October 2012, 153 consecutive patients underwent SG. All data were prospectively collected in a computerized database.

Results

This series comprised 119 females and 34 males with a median age of 46 years and a median preoperative BMI of 42.3 kg/m2. The median EWL was 53.0 % after 18.4 months of follow-up. The median postoperative BMI was 33.3 kg/m2 (range 19.7–56.1 kg/m2). Eight patients (5.2 %) required re-laparoscopy to manage postoperative hemorrhage (3.3 %) and leakage (1.9 %). Neither abdominal drains nor postoperative contrast-swallow studies were successful in diagnosing hemorrhage or leaks in our patients.

Conclusion

SG is an effective procedure to achieve significant short-term weight loss. Clinical signs, such as tachycardia, pain, fever and hypotension, provide the best evidence of the presence of postoperative leakage or bleeding. An early diagnosis of these complications is the key to ensuring adequate treatment with immediate re-laparoscopy.
Literature
1.
go back to reference Himpens J, Dobbeleir J. Peeters G long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252:319–24.PubMedCrossRef Himpens J, Dobbeleir J. Peeters G long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252:319–24.PubMedCrossRef
2.
go back to reference Givon-Madhala O, Spector R, Wasserberg N, et al. Technical aspects of laparoscopic sleeve gastrectomy in 25 morbidly obese patients. Obes Surg. 2007;17:722–7.PubMedCrossRef Givon-Madhala O, Spector R, Wasserberg N, et al. Technical aspects of laparoscopic sleeve gastrectomy in 25 morbidly obese patients. Obes Surg. 2007;17:722–7.PubMedCrossRef
3.
go back to reference Gluck B, Movitz B, Jansma S, et al. Laparoscopic sleeve gastrectomy is a safe and effective bariatric procedure for the lower BMI (35.0–43.0 kg/m2) population. Obes Surg. 2011;21:1168–71.PubMedCentralPubMedCrossRef Gluck B, Movitz B, Jansma S, et al. Laparoscopic sleeve gastrectomy is a safe and effective bariatric procedure for the lower BMI (35.0–43.0 kg/m2) population. Obes Surg. 2011;21:1168–71.PubMedCentralPubMedCrossRef
4.
go back to reference D’Hondt M, Vanneste S, Pottel H, et al. Laparoscopic sleeve gastrectomy as a single-stage procedure for the treatment of morbid obesity and the resulting quality of life, resolution of comorbidities, food tolerance, and 6-year weight loss. Surg Endosc. 2011;28:2498–504.CrossRef D’Hondt M, Vanneste S, Pottel H, et al. Laparoscopic sleeve gastrectomy as a single-stage procedure for the treatment of morbid obesity and the resulting quality of life, resolution of comorbidities, food tolerance, and 6-year weight loss. Surg Endosc. 2011;28:2498–504.CrossRef
5.
go back to reference Rubin M, Yehoshua RT, Stein M, et al. Laparoscopic sleeve gastrectomy with minimal morbidity: early results in 120 morbidly obese patients. Obes Surg. 2008;18:1567–70.PubMedCrossRef Rubin M, Yehoshua RT, Stein M, et al. Laparoscopic sleeve gastrectomy with minimal morbidity: early results in 120 morbidly obese patients. Obes Surg. 2008;18:1567–70.PubMedCrossRef
6.
go back to reference Tagaya N, Kasama K, Kikkawa R, et al. Experience with laparoscopic sleeve gastrectomy for morbid versus super morbid obesity. Obes Surg. 2009;19:1371–6.PubMedCrossRef Tagaya N, Kasama K, Kikkawa R, et al. Experience with laparoscopic sleeve gastrectomy for morbid versus super morbid obesity. Obes Surg. 2009;19:1371–6.PubMedCrossRef
7.
go back to reference Tucker ON, Szomstein S, Rosenthal RJ. Indications for sleeve gastrectomy as a primary procedure for weight loss in the morbidly obese. J Gastrointest Surg. 2008;12:662–7.PubMedCrossRef Tucker ON, Szomstein S, Rosenthal RJ. Indications for sleeve gastrectomy as a primary procedure for weight loss in the morbidly obese. J Gastrointest Surg. 2008;12:662–7.PubMedCrossRef
8.
go back to reference Sakran N, Goitein D, Raziel A, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2012;27(1):240–5 (Jun 30 Epub ahead of print).PubMedCrossRef Sakran N, Goitein D, Raziel A, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2012;27(1):240–5 (Jun 30 Epub ahead of print).PubMedCrossRef
9.
go back to reference Burgos AM, Braghetto I, Csendes A, et al. Gastric leak after laparoscopic-sleeve gastrectomy for obesity. Obes Surg. 2009;19:1672–7.PubMedCrossRef Burgos AM, Braghetto I, Csendes A, et al. Gastric leak after laparoscopic-sleeve gastrectomy for obesity. Obes Surg. 2009;19:1672–7.PubMedCrossRef
10.
go back to reference Deitel M, Crosby RD, Gagner M. The first international consensus summit for sleeve gastrectomy (SG), New York, October 25–27, 2007. Obes Surg. 2008;18:487–96.PubMedCrossRef Deitel M, Crosby RD, Gagner M. The first international consensus summit for sleeve gastrectomy (SG), New York, October 25–27, 2007. Obes Surg. 2008;18:487–96.PubMedCrossRef
11.
go back to reference Gagner M, Deitel M, Kalberer TL, et al. The Second international consensus summit for sleeve gastrectomy, March 19–21, 2009. Surg Obes Relat Dis. 2009;5:476–85.PubMedCrossRef Gagner M, Deitel M, Kalberer TL, et al. The Second international consensus summit for sleeve gastrectomy, March 19–21, 2009. Surg Obes Relat Dis. 2009;5:476–85.PubMedCrossRef
12.
go back to reference Tomikawa M, Korenaga D, Akahoshi T, et al. Quality of life after laparoscopy-assisted pylorus-preserving gastrectomy: an evaluation using a questionnaire mailed to the patients. Surg Today. 2012;42(7):625–32.PubMedCrossRef Tomikawa M, Korenaga D, Akahoshi T, et al. Quality of life after laparoscopy-assisted pylorus-preserving gastrectomy: an evaluation using a questionnaire mailed to the patients. Surg Today. 2012;42(7):625–32.PubMedCrossRef
13.
go back to reference Csendes A, Burdiles P, Burgos AM, et al. Conservative management of anastomotic leaks after 557 open gastric bypasses. Obes Surg. 2005;15:1252–6.PubMedCrossRef Csendes A, Burdiles P, Burgos AM, et al. Conservative management of anastomotic leaks after 557 open gastric bypasses. Obes Surg. 2005;15:1252–6.PubMedCrossRef
14.
go back to reference Mognol P, Chosidow D, Marmuse JP. Laparoscopic sleeve gastrectomy as an initial bariatric operation for high-risk patients: initial results in 10 patients. Obes Surg. 2005;15:1030–3.PubMedCrossRef Mognol P, Chosidow D, Marmuse JP. Laparoscopic sleeve gastrectomy as an initial bariatric operation for high-risk patients: initial results in 10 patients. Obes Surg. 2005;15:1030–3.PubMedCrossRef
15.
go back to reference Clinical Issues Committee of American Society for Metabolic and Bariatric Surgery. Sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis. 2007;3:573–6.CrossRef Clinical Issues Committee of American Society for Metabolic and Bariatric Surgery. Sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis. 2007;3:573–6.CrossRef
16.
go back to reference Silecchia G, Boru C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg. 2006;16:1138–44.PubMedCrossRef Silecchia G, Boru C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg. 2006;16:1138–44.PubMedCrossRef
17.
go back to reference Marquez M, Ayza M, Lozano R, et al. Gastric leak after laparoscopic sleeve gastrectomy. Obes Surg. 2010;10:1303–11. Marquez M, Ayza M, Lozano R, et al. Gastric leak after laparoscopic sleeve gastrectomy. Obes Surg. 2010;10:1303–11.
18.
go back to reference Aurora A, Khaitan L, Saber A. Sleeve gastrectomy and the risk of a leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26:1509–15.PubMedCrossRef Aurora A, Khaitan L, Saber A. Sleeve gastrectomy and the risk of a leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26:1509–15.PubMedCrossRef
19.
go back to reference Dallal RM, Bailey L, Nahmias N. Back to basics—clinical diagnosis in bariatric surgery: routine drains and upper GI series are unnecessary. Surg Endosc. 2007;21:2268–71.PubMedCrossRef Dallal RM, Bailey L, Nahmias N. Back to basics—clinical diagnosis in bariatric surgery: routine drains and upper GI series are unnecessary. Surg Endosc. 2007;21:2268–71.PubMedCrossRef
20.
go back to reference Goitein D, Goitein O, Feigin A, et al. Sleeve gastrectomy: radiologic patterns after surgery. Surg Endosc. 2009;23:1559–63.PubMedCrossRef Goitein D, Goitein O, Feigin A, et al. Sleeve gastrectomy: radiologic patterns after surgery. Surg Endosc. 2009;23:1559–63.PubMedCrossRef
21.
go back to reference Roa PE, Kaidar-Person O, Pinto D, et al. Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short-term outcome. Obes Surg. 2006;16:1323–6.PubMedCrossRef Roa PE, Kaidar-Person O, Pinto D, et al. Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short-term outcome. Obes Surg. 2006;16:1323–6.PubMedCrossRef
22.
go back to reference Alvarez Uslar R, Molina H, Torres O, Cancino A. Total gastrectomy with or without abdominal drains. A prospective randomized trial. Rev Esp Enferm Dig. 2005;97:562–9.PubMedCrossRef Alvarez Uslar R, Molina H, Torres O, Cancino A. Total gastrectomy with or without abdominal drains. A prospective randomized trial. Rev Esp Enferm Dig. 2005;97:562–9.PubMedCrossRef
23.
go back to reference Kim J, Lee J, Hyung WJ, et al. Gastric cancer surgery without drains: a prospective randomized trial. J Gastrointest Surg. 2004;8:727–32.PubMedCrossRef Kim J, Lee J, Hyung WJ, et al. Gastric cancer surgery without drains: a prospective randomized trial. J Gastrointest Surg. 2004;8:727–32.PubMedCrossRef
24.
go back to reference Brockmeyer J, Simon T, Jacob R, et al. Upper gastrointestinal swallow study following bariatric surgery: institutional review and review of the literature. Obes Surg. 2012;22:1039–43.PubMedCrossRef Brockmeyer J, Simon T, Jacob R, et al. Upper gastrointestinal swallow study following bariatric surgery: institutional review and review of the literature. Obes Surg. 2012;22:1039–43.PubMedCrossRef
25.
go back to reference Bertucci W, White S, Yadegar J, et al. Routine postoperative upper gastroesophageal imaging is unnecessary after laparoscopic Roux-en-Y gastric bypass. Am Surg. 2006;72:862–4.PubMed Bertucci W, White S, Yadegar J, et al. Routine postoperative upper gastroesophageal imaging is unnecessary after laparoscopic Roux-en-Y gastric bypass. Am Surg. 2006;72:862–4.PubMed
26.
go back to reference Jurowich C, Thalheimer A, Seyfried F, et al. Gastric leakage after sleeve gastrectomy-clinical presentation and therapeutic options. Langenbecks Arch Surg. 2011;396:981–7.PubMedCrossRef Jurowich C, Thalheimer A, Seyfried F, et al. Gastric leakage after sleeve gastrectomy-clinical presentation and therapeutic options. Langenbecks Arch Surg. 2011;396:981–7.PubMedCrossRef
27.
go back to reference Triantafyllidis G, Lazoura O, Sioka E, et al. Anatomy andcomplications following laparoscopic sleeve gastrectomy: radiological evaluation and imaging pitfalls. Obes Surg. 2010;21:473–8.CrossRef Triantafyllidis G, Lazoura O, Sioka E, et al. Anatomy andcomplications following laparoscopic sleeve gastrectomy: radiological evaluation and imaging pitfalls. Obes Surg. 2010;21:473–8.CrossRef
28.
go back to reference Bellanger DE, Greenway FL. Laparoscopic sleeve gastrectomy, 529 cases without a leak: short-term results and technical considerations. Obes Surg. 2011;21:146–50.PubMedCrossRef Bellanger DE, Greenway FL. Laparoscopic sleeve gastrectomy, 529 cases without a leak: short-term results and technical considerations. Obes Surg. 2011;21:146–50.PubMedCrossRef
29.
go back to reference Rosenthal RJ. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8:8–19.PubMedCrossRef Rosenthal RJ. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8:8–19.PubMedCrossRef
30.
go back to reference Parikh M, Issa R, McCrillis A, et al. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg. 2013;257:231–7.PubMedCrossRef Parikh M, Issa R, McCrillis A, et al. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg. 2013;257:231–7.PubMedCrossRef
31.
go back to reference Baker RS, Foote J, Kemmeter P, et al. The science of stapling and leaks. Obes Surg. 2004;14:1290–8.PubMedCrossRef Baker RS, Foote J, Kemmeter P, et al. The science of stapling and leaks. Obes Surg. 2004;14:1290–8.PubMedCrossRef
32.
go back to reference Fuks D, Verhaeghe P, Brehant O, et al. Results of laparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity. Surgery. 2009;145:106–13.PubMedCrossRef Fuks D, Verhaeghe P, Brehant O, et al. Results of laparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity. Surgery. 2009;145:106–13.PubMedCrossRef
33.
go back to reference Fukumoto R, Orlina J, McGinty J, et al. Use of polyflex stents in treatment of acute esophageal and gastric leaks after bariatric surgery. Surg Obes Relat Dis. 2006;2:570–2.CrossRef Fukumoto R, Orlina J, McGinty J, et al. Use of polyflex stents in treatment of acute esophageal and gastric leaks after bariatric surgery. Surg Obes Relat Dis. 2006;2:570–2.CrossRef
34.
go back to reference Baltasar A, Bou R, Bengochea M, et al. Use of a Roux Limb to correct esophagogastric junction fistulas after sleeve gastrectomy. Obes Surg. 2007;17:1408–10.PubMedCrossRef Baltasar A, Bou R, Bengochea M, et al. Use of a Roux Limb to correct esophagogastric junction fistulas after sleeve gastrectomy. Obes Surg. 2007;17:1408–10.PubMedCrossRef
35.
go back to reference Baltasar A, Serra C, Bengochea M, et al. Use of Roux limb as remedial surgery for sleeve gastrectomy fistulas. Surg Obes Relat Dis. 2008;4:759–63.PubMedCrossRef Baltasar A, Serra C, Bengochea M, et al. Use of Roux limb as remedial surgery for sleeve gastrectomy fistulas. Surg Obes Relat Dis. 2008;4:759–63.PubMedCrossRef
Metadata
Title
Results and complications after laparoscopic sleeve gastrectomy
Authors
Reinhard Mittermair
Robert Sucher
Alexander Perathoner
Publication date
01-07-2014
Publisher
Springer Japan
Published in
Surgery Today / Issue 7/2014
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-013-0688-0

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