Araştırma Makalesi
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Different parameter of the detection and management of sleeve gastrectomy leakage; our expert bariatric clinic results

Yıl 2025, Cilt: 8 Sayı: 4, 394 - 397, 31.12.2025
https://doi.org/10.36516/jocass.1781159

Öz

Introduction: Laparoscopic sleeve gastrectomy is being performed with increasing frequency for treatment of obesity. In this study, the aim is to explain the management of sleeve gastrectomy leakage.
Material and Methods: A total of 1505 patients on whom we have performed sleeve gastrectomy as a standard treatment for morbid obesity in the last 10 years were included in this study. Thirty-one of these patients with staple line leakage were included. Age, gender, body mass index and comorbidity rates as well as procalcitonin and C-reactive protein levels of the patients were recorded as data.
Results: Of the total 31 patients, 12 (0.7973%) were from our center, and 19 were referred from an external center. The mean age of the patients was 34.46 years (range 17-62 years). The average leak detection time was 21.13 days. All of the 31 patients were stenting after the postoperative period. The mean procalcitonin level of the patients with no leakage was 0.4 ng/mL, whereas the level of the patients with leakage was 4.59 ng/mL. Mean C-reactive protein levels of the patients without leakage was 15.84 mg/L, while the level of the patients with leakage was 251.034 mg/L. The mean body mass index was 42.52. The mean hospital stay was 26.34 days (range 6-61 days).
Discussion: Our study demonstrates that proper treatment and early detection of leakage are important. Early detection of C-reactive protein and procalcitonin after sleeve gastrectomy is a warning sign to help detect a leakage, which is important to patient’s treatment.

Kaynakça

  • 1.Angrisani L, Santonicola A, Iovino P, et al. Bariatric Surgery and Endoluminal Procedures: IFSO Worldwide Survey 2014. Obesity Surgery. 2017;27(9):2279-2289. [Crossref]
  • 2.Scopinaro N. The IFSO and obesity surgery throughout the world. ObesSurg. 1998 Feb;8(1):3-8. 3.Silecchia G, Iossa A. Complications of staple line and anastomoses following laparoscopic bariatric surgery. Annals of Gastroenterology. 2018;31(1):56-64. [Crossref]
  • 4.Gagner M, Buchwald JN. Comparison of laparoscopic sleeve gastrectomy leak rates in four staple-line reinforcement options: a systematic review. Surg Obes Relat Dis. 2014 Jul-Aug;10(4):713-23. [Crossref]
  • 5.Abou Rached A, Basile M, El Masri H. Gastric leaks post sleeve gastrectomy: Review of its prevention and management. World Journal of Gastroenterology: WJG. 2014;20(38):13904-13910. [Crossref]
  • 6.Ferrer-Márquez M, Belda-Lozano R. Technical Controversies in Laparoscopic Sleeve Gastrectomy. Obes Surg. 2012;22:182–187. [Crossref]
  • 7.Iossa A, Abdelgawad M, Watkins BM, Silecchia G. Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors. Langenbecks Arch Surg. 2016 Sep;401(6):757-66. [Crossref]
  • 8.Hoyuela C. Five-year outcomes of laparoscopic sleeve gastrectomy as a primary procedure for morbid obesity: A prospective study. World Journal of Gastrointestinal Surgery. 2017;9(4):109-117. [Crossref]
  • 9.Cottam D, Qureshi FG, Mattar SG, Sharma S, Holover S, Bonanomi G, Ramanathan R, Schauer P. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006 Jun;20(6):859-63.
  • 10.Acquafresca PA, Palermo M, Rogula T, Duza GE, Serra E. Most common robotic bariatric procedures: review and technical aspects. Annals of Surgical Innovation and Research. 2015;9:9. [Crossref]
  • 11.Warner DL, Sasse KC. Technical Details of Laparoscopic Sleeve Gastrectomy Leading to Lowered Leak Rate: Discussion of 1070 Consecutive Cases. Minimally Invasive Surgery. 2017;2017:4367059. [Crossref]
  • 12.Bekheit M, Katri KM, Nabil W, Sharaan MA, El Kayal ES. Earliest signs and management of leakage after bariatric surgeries: Single institute experience. Alex J Med. 2013;49:29–33. [Crossref]
  • 13.Oshiro T, Kasama K, Umezawa A, et al. Successful management of refractory staple line leakage at the esophagogastric junction after a sleeve gastrectomy using the HANAROSTENT. Obes Surg. 2010;20:530–4.
  • 14.Marres CCM, van de Ven AWH, Leijssen LGJ, Verbeek PCM, Bemelman WA, Buskens CJ. Colorectal anastomotic leak: delay in reintervention after false-negative computed tomography scan is a reason for concern. Techniques in Coloproctology. 2017;21(9):709-714. [Crossref]
  • 15.Kim Y, Crookes PF. Complications of Bariatric Surgery. Essentials and Controversies in Bariatric Surgery. [Crossref] 16.Frask A, Orłowski M, Dowgiałło-Wnukiewicz N, Lech P, Gajewski K, Michalik M. Clinical evaluation of C-reactive protein and procalcitonin for the early detection of postoperative complications after laparoscopic sleeve gastrectomy. Videosurgery and other Miniinvasive Techniques. 2017;12(2):160-165. [Crossref]
  • 17.Albanopoulos K, Alevizos L, Natoudi M, et al. C-reactive protein, white blood cells, and neutrophils as early predictors of postoperative complications in patients undergoing laparoscopic sleeve gastrectomy. Surg Endosc. 2013 Mar;27(3):864-71. [Crossref]
  • 18.Kassir R, Blanc P, Bruna Tibalbo LM, Breton C, Lointier P. C-Reactive protein and procalcitonin for the early detection of postoperative complications after sleeve gastrectomy: preliminary study in 97 patients. Surg Endosc. 2015 Jun;29(6):1439-44. [Crossref]
  • 19.Muñoz JL, Ruiz-Tovar J, Miranda E, Berrio DL, Moya P, Gutiérrez M, Flores R, Picó C, Pérez A. C-Reactive Protein and Procalcitonin as Early Markers of Septic Complications after Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients Within an Enhanced Recovery After Surgery Program. J Am Coll Surg. 2016 May;222(5):831-7. [Crossref]
  • 20.Ruiz-Tovar J, Muñoz JL, Gonzalez J, Garcia A, Ferrigni C, Jimenez M, Duran M. C-reactive protein, fibrinogen, and procalcitonin levels as early markers of staple line leak after laparoscopic sleeve gastrectomy in morbidly obese patients within an Enhanced Recovery After Surgery (ERAS) program. Surg Endosc. 2017 Dec;31(12):5283-5288. [Crossref]
  • 21.Lemanowicz A, Serafin Z. Imaging of patients treated with bariatric surgery. Polish Journal of Radiology. 2014;79:12-19. [Crossref]
  • 22.Reynolds A. Obesity and medical imaging challenges. Radiol Technol. 2011 Jan-Feb;82(3):219-39.
  • 23.Mattarella A. Medical imaging's role in bariatric surgery. Radiol Technol. 2011 Mar-Apr;82(4):347-64.
  • 24.Martin Del Campo SE, Mikami DJ, Needleman BJ, Noria SF. Endoscopic stent placement for treatment of sleeve gastrectomy leak: a single institution experience with fully covered stents. Surg Obes Relat Dis. 2018 Apr;14(4):453-461. [Crossref]
  • 25.Abraham A, Rizvon K, Singh J, Siddiqui G, Prasad A, Rashid S, Vardaros M, Garg V, Subramani K, Mustacchia P. Successful Management of a Gastric Sleeve Leak with an Endoscopic Stent. Case Reports in Gastrointestinal Medicine. 2012. [Crossref]
  • 26.Rosenthal RJ, Diaz AA, Arvidsson D. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8(1):8–19.
  • 27.Albanopoulos K, Alevizos L, Linardoutsos D, Menenakos E, Stamou K, Vlachos K, Zografos G, Leandros E. Routine abdominal drains after laparoscopic sleeve gastrectomy: a retrospective review of 353 patients. Obes Surg. 2011 Jun;21(6):687-91. [Crossref]
  • 28.Abou Rached A, Basile M, El Masri H. Gastric leaks post sleeve gastrectomy: Review of its prevention and management. World Journal of Gastroenterology: WJG. 2014;20(38):13904-13910. [Crossref]
  • 29.Le NTT, Robinson J, Lewis SJ. Obese patients and radiography literature: what do we know about a big issue? Journal of Medical Radiation Sciences. 2015;62(2):132-141. [Crossref]

Tüp mide ameliyatı kaçağının tespiti ve yönetiminin farklı parametreleri; bariatrik kliniğimizin sonuçları

Yıl 2025, Cilt: 8 Sayı: 4, 394 - 397, 31.12.2025
https://doi.org/10.36516/jocass.1781159

Öz

Giriş: Obezite tedavisinde laparoskopik sleeve gastrektomi giderek artan sıklıkta uygulanmaktadır. Bu çalışmada sleeve gastrektomi kaçağının yönetimini açıklamak amaçlanmıştır.
Gereç ve Yöntemler: Son 10 yılda morbid obezite için standart tedavi olarak sleeve gastrektomi uyguladığımız toplam 1505 hasta çalışmaya dahil edildi. Bu hastalardan stapler hattı kaçağı olan 31 hasta çalışmaya dahil edildi. Hastaların yaş, cinsiyet, vücut kitle indeksi, eşlik eden hastalık oranları ile prokalsitonin ve C-reaktif protein düzeyleri veri olarak kaydedildi.
Sonuç Toplam 31 hastanın 12'si (%0,7973) merkezimizden, 19'u ise dış merkezden sevk edilmişti. Hastaların ortalama yaşı 34,46 yıl (aralığı 17-62 yıl) idi. Ortalama kaçak tespit süresi 21,13 gündü. 31 hastanın tamamına postoperatif dönemde stent takıldı. Sızıntısı olmayan hastaların ortalama prokalsitonin seviyesi 0,4 ng/mL iken, sızıntısı olan hastaların seviyesi 4,59 ng/mL olarak bulundu. Sızıntısı olmayan hastaların ortalama C-reaktif protein seviyesi 15,84 mg/L iken, sızıntısı olan hastaların seviyesi 251,034 mg/L olarak bulundu. Ortalama vücut kitle indeksi 42,52 idi. Ortalama hastanede kalış süresi 26,34 gündü (aralığı 6-61 gün).
Tartışma: Çalışmamız, sızıntının uygun tedavisinin ve erken tespitinin önemli olduğunu göstermektedir. Tüp mide ameliyatından sonra C-reaktif protein ve prokalsitoninin erken tespiti, hastanın tedavisi için önemli olan sızıntının tespit edilmesine yardımcı olan bir uyarı işaretidir.

Kaynakça

  • 1.Angrisani L, Santonicola A, Iovino P, et al. Bariatric Surgery and Endoluminal Procedures: IFSO Worldwide Survey 2014. Obesity Surgery. 2017;27(9):2279-2289. [Crossref]
  • 2.Scopinaro N. The IFSO and obesity surgery throughout the world. ObesSurg. 1998 Feb;8(1):3-8. 3.Silecchia G, Iossa A. Complications of staple line and anastomoses following laparoscopic bariatric surgery. Annals of Gastroenterology. 2018;31(1):56-64. [Crossref]
  • 4.Gagner M, Buchwald JN. Comparison of laparoscopic sleeve gastrectomy leak rates in four staple-line reinforcement options: a systematic review. Surg Obes Relat Dis. 2014 Jul-Aug;10(4):713-23. [Crossref]
  • 5.Abou Rached A, Basile M, El Masri H. Gastric leaks post sleeve gastrectomy: Review of its prevention and management. World Journal of Gastroenterology: WJG. 2014;20(38):13904-13910. [Crossref]
  • 6.Ferrer-Márquez M, Belda-Lozano R. Technical Controversies in Laparoscopic Sleeve Gastrectomy. Obes Surg. 2012;22:182–187. [Crossref]
  • 7.Iossa A, Abdelgawad M, Watkins BM, Silecchia G. Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors. Langenbecks Arch Surg. 2016 Sep;401(6):757-66. [Crossref]
  • 8.Hoyuela C. Five-year outcomes of laparoscopic sleeve gastrectomy as a primary procedure for morbid obesity: A prospective study. World Journal of Gastrointestinal Surgery. 2017;9(4):109-117. [Crossref]
  • 9.Cottam D, Qureshi FG, Mattar SG, Sharma S, Holover S, Bonanomi G, Ramanathan R, Schauer P. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006 Jun;20(6):859-63.
  • 10.Acquafresca PA, Palermo M, Rogula T, Duza GE, Serra E. Most common robotic bariatric procedures: review and technical aspects. Annals of Surgical Innovation and Research. 2015;9:9. [Crossref]
  • 11.Warner DL, Sasse KC. Technical Details of Laparoscopic Sleeve Gastrectomy Leading to Lowered Leak Rate: Discussion of 1070 Consecutive Cases. Minimally Invasive Surgery. 2017;2017:4367059. [Crossref]
  • 12.Bekheit M, Katri KM, Nabil W, Sharaan MA, El Kayal ES. Earliest signs and management of leakage after bariatric surgeries: Single institute experience. Alex J Med. 2013;49:29–33. [Crossref]
  • 13.Oshiro T, Kasama K, Umezawa A, et al. Successful management of refractory staple line leakage at the esophagogastric junction after a sleeve gastrectomy using the HANAROSTENT. Obes Surg. 2010;20:530–4.
  • 14.Marres CCM, van de Ven AWH, Leijssen LGJ, Verbeek PCM, Bemelman WA, Buskens CJ. Colorectal anastomotic leak: delay in reintervention after false-negative computed tomography scan is a reason for concern. Techniques in Coloproctology. 2017;21(9):709-714. [Crossref]
  • 15.Kim Y, Crookes PF. Complications of Bariatric Surgery. Essentials and Controversies in Bariatric Surgery. [Crossref] 16.Frask A, Orłowski M, Dowgiałło-Wnukiewicz N, Lech P, Gajewski K, Michalik M. Clinical evaluation of C-reactive protein and procalcitonin for the early detection of postoperative complications after laparoscopic sleeve gastrectomy. Videosurgery and other Miniinvasive Techniques. 2017;12(2):160-165. [Crossref]
  • 17.Albanopoulos K, Alevizos L, Natoudi M, et al. C-reactive protein, white blood cells, and neutrophils as early predictors of postoperative complications in patients undergoing laparoscopic sleeve gastrectomy. Surg Endosc. 2013 Mar;27(3):864-71. [Crossref]
  • 18.Kassir R, Blanc P, Bruna Tibalbo LM, Breton C, Lointier P. C-Reactive protein and procalcitonin for the early detection of postoperative complications after sleeve gastrectomy: preliminary study in 97 patients. Surg Endosc. 2015 Jun;29(6):1439-44. [Crossref]
  • 19.Muñoz JL, Ruiz-Tovar J, Miranda E, Berrio DL, Moya P, Gutiérrez M, Flores R, Picó C, Pérez A. C-Reactive Protein and Procalcitonin as Early Markers of Septic Complications after Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients Within an Enhanced Recovery After Surgery Program. J Am Coll Surg. 2016 May;222(5):831-7. [Crossref]
  • 20.Ruiz-Tovar J, Muñoz JL, Gonzalez J, Garcia A, Ferrigni C, Jimenez M, Duran M. C-reactive protein, fibrinogen, and procalcitonin levels as early markers of staple line leak after laparoscopic sleeve gastrectomy in morbidly obese patients within an Enhanced Recovery After Surgery (ERAS) program. Surg Endosc. 2017 Dec;31(12):5283-5288. [Crossref]
  • 21.Lemanowicz A, Serafin Z. Imaging of patients treated with bariatric surgery. Polish Journal of Radiology. 2014;79:12-19. [Crossref]
  • 22.Reynolds A. Obesity and medical imaging challenges. Radiol Technol. 2011 Jan-Feb;82(3):219-39.
  • 23.Mattarella A. Medical imaging's role in bariatric surgery. Radiol Technol. 2011 Mar-Apr;82(4):347-64.
  • 24.Martin Del Campo SE, Mikami DJ, Needleman BJ, Noria SF. Endoscopic stent placement for treatment of sleeve gastrectomy leak: a single institution experience with fully covered stents. Surg Obes Relat Dis. 2018 Apr;14(4):453-461. [Crossref]
  • 25.Abraham A, Rizvon K, Singh J, Siddiqui G, Prasad A, Rashid S, Vardaros M, Garg V, Subramani K, Mustacchia P. Successful Management of a Gastric Sleeve Leak with an Endoscopic Stent. Case Reports in Gastrointestinal Medicine. 2012. [Crossref]
  • 26.Rosenthal RJ, Diaz AA, Arvidsson D. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8(1):8–19.
  • 27.Albanopoulos K, Alevizos L, Linardoutsos D, Menenakos E, Stamou K, Vlachos K, Zografos G, Leandros E. Routine abdominal drains after laparoscopic sleeve gastrectomy: a retrospective review of 353 patients. Obes Surg. 2011 Jun;21(6):687-91. [Crossref]
  • 28.Abou Rached A, Basile M, El Masri H. Gastric leaks post sleeve gastrectomy: Review of its prevention and management. World Journal of Gastroenterology: WJG. 2014;20(38):13904-13910. [Crossref]
  • 29.Le NTT, Robinson J, Lewis SJ. Obese patients and radiography literature: what do we know about a big issue? Journal of Medical Radiation Sciences. 2015;62(2):132-141. [Crossref]
Toplam 27 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Genel Cerrahi
Bölüm Araştırma Makalesi
Yazarlar

Ali Durmuş 0000-0002-1752-1668

Gönderilme Tarihi 10 Eylül 2025
Kabul Tarihi 7 Kasım 2025
Yayımlanma Tarihi 31 Aralık 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 8 Sayı: 4

Kaynak Göster

APA Durmuş, A. (2025). Different parameter of the detection and management of sleeve gastrectomy leakage; our expert bariatric clinic results. Journal of Cukurova Anesthesia and Surgical Sciences, 8(4), 394-397. https://doi.org/10.36516/jocass.1781159
https://dergipark.org.tr/tr/download/journal-file/11303