Endoscopic Repair of Large Gastric Perforation Following Pneumatic Dilation of Sleeve Gastrectomy Stenosis
AbstractSleeve gastrectomy has become the most commonly performed bariatric surgery in the USA (English et al.in Surg Obes Relat Dis. 14(3):259 –63,2018). Despite the rising popularity of this procedure, gastric stenosis is a known complication with an incidence of up to 4% (Rebibo et al. in Obes Surg. 26(5):995 –1001,2016). Endoscopic pneumatic balloon dilation is increasingly utilized to treat this condition and to ameliorate symptoms of nausea, vomiting, reflux, and/or dysphagia (Dhorepatil et al. in BMC Surg. 18(1):52,2018). Pneumatic balloon dilation does carry a risk of gastric perforation of up to 3% in the limited literature to date (Donatelli et al. in Surg Obes Relat Dis. 13(6):943 –50,2017), historically requiring immediate surgical consultation for repair (Donatelli et al. Surg Obes Relat Dis. 13(6):943 –50,2017). In this case series, two cases of gastric perforation during pneumatic dilation for gastric sleeve stenosis were repaired successfully endoscopically with use of an endoscopic suturing system, resulting in correction of gastric defect and elimination of symptoms.
We present a query of national bariatric surgery data investigating the efficacy of concurrent laparoscopic sleeve gastrectomy and paraesophageal hiatal hernia repair (LSGPEHR) as compared to laparoscopic sleeve gastrectomy (LSG).
This Video demonstrates a case where accidental stapling of the temperature probe occurred during performance of a Laparoscopic Sleeve gastrectomy. The temp robe was released after sharp dissection and we closed the resulting gastrotomy in two layers and secured omentum over the repair. The patient has done well in the psotoperative period. While our institution and OR team has a long-standing policy of no placement of esophageal temperature probes, or naso- or orogastric tubes during any bariatric or foregut case that will require stapling.
PMID: 31519486 [PubMed - as supplied by publisher]
AbstractBackgroundControversy exists regarding the clinical utility of routine preoperative upper gastrointestinal (GI) fluoroscopy in morbid obese patients undergoing laparoscopic sleeve gastrectomy (LSG). The aim of our study was to determine the efficacy of these studies in detecting hiatal hernias (HH).MethodsThe institution ’s prospectively maintained, IRB-approved database was retrospectively queried to identify all consecutive patients who underwent LSG between 2011 and 2017. All patients underwent routine preoperative upper GI fluoroscopy. Reports from all imaging studies were retrospectively reviewed and com...
ConclusionSynchronous VHR and BS in a bariatric unit is feasible with low recurrence rate. Laparoscopic VHR has lower complication rates than open, apart from seroma formation. Patients with diabetes have higher risk of infection.
This study aimed to assess practice patterns regarding concomitant HH repair (HHR) during laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). The incidence of concomitant HHR with LSG or LRYGB was analyzed using the 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. One hundred thirty thousand, seven hundred seventy-two patients underwent RYGB (30.5%) and LSG (69.5%). Concomitant HHR was more common, despite less GERD, in SG patients compared to RYGB (21.0% vs 10.8%,p
ConclusionsOur results showed that primary LSG is a durable primary bariatric procedure with sustained weight loss and a high resolution of comorbidities at 10 years, but about half the patients had de novo GERD. The need for conversion to RYGB was 16.9% at 10 years.
We present a case of 60-year-old man with a body mass index of 45.3 kg/m2 with a large recurrent ventral hernia. We performed a lap sleeve gastrectomy with laparoendoscopic anterior component separation with IPOM. The operative steps included hernia contents reduction, conventional sleeve gastrectomy, anterior component separation on either side, intra-corporeal closure of hernia defect and placement of a composite mesh. Patient recovery was uneventful. Concomitant bariatric surgery with laparoendoscopic component separation with IPOM may be safe, but more studies are required.
ConclusionsDouble Baltazar technique is a successful and feasible treatment option for patients presenting with two gastric fistulae following sleeve gastrectomy. This is the first case report describing this new technique, and its success should encourage more similar trials and avoid more aggressive surgical options such as total gastrectomy or gastric bypass.
ConclusionsRYGB may increase the risk of CDI hospitalization when compared to VSG and VHR controls. This data suggest VSG may be a better bariatric choice when post-surgical CDI risk is a concern.