Our approach to early and late complications of laparoscopic sleeve gastrectomy patients

Öz

Aim: Laparoscopic Sleeve Gastrectomy (LSG) is used as an effective surgical method in the treatment of morbid obesity. In our study, we investigated the early and late complications and treatment methods of our patients who underwent LSG.
Material and method: 390 patients between the ages of 18-70 who were operated between January 2016 and December 2020 were included in the study. Patient records were retrospectively scanned electronically and the results were recorded.
Results: Laparoscopic sleeve gastrectomy surgery was performed on 390 morbidly obese patients. Of the patients, 310 (78.1%) were female, 80 (21.9%) were male, with a mean age of 42.1 years (22-65) and 42.9 years (24-70) patients. Complications were observed in 22 (5.64%) patients with LSG. Ten (2.56%) of the patients developed complications in the early period, 9 (2.33%) developed complications in the late period, and 3 (0.75%) of them developed both early and late complications.
Early complications; Postoperative early anastomosis leakage in 4 (1%) patients, atelectasis in 2 (0.5%) patients, bleeding in 1 (0.25%) patient, dehydration in 1 (0.25%) patient, intra-abdominal collection in 1 (0.25%) patient, pleurosis in 1 (0.25%) patient was detected. Stent was applied to the patients with leakage, and the patient with bleeding was operated. Other patients received medical treatment.
Late complications; Minimal stenosis causing reflux in the incisura angularis was found in 5 (1.25%) patients, and trocar port hernia was found in 4 (1%) patients.
Early and late complication; Late complications were also observed in 3 (0.75%) patients who underwent stenting due to early leakage. Late pyloric stenosis was detected in 1 (0.25%) of these patients, gastric ulcers in 1 (0.25%) and esophagocardial stenosis in 1 (0.25%) patient. Patients with trocar port hernia and patients with severe symptomatic incisura angularis stenosis were treated surgically, while other patients were treated medically. No mortality was observed.
Conclusion: Laparoscopic sleeve gastrectomy, which is an effective method in the treatment of morbid obesity, can have serious early and late complications. For this reason, we believe that it will be safer to operate them in centers where necessary intensive care conditions and endoscopic interventions such as stenting can be performed quickly and reliably.

Anahtar Kelimeler

• Laparoscopic sleeve gastrectomy
• leak
• stent
• complication

Laparoskopik sleeve gastrektomi hastalarımızın erken ve geç komplikasyonlarına yaklaşımımız

Öz

Giriş: Laparaskopik Sleeve Gastrektomi (LSG) morbid obezite tedavisinde etkili bir cerrahi yöntem olarak kullanılmaktadır. Çalışmamızda LSG yaptığımız hastalarımızın erken ve geç dönem komplikasyonlarını ve tedavi yöntemlerini araştırdık.
Gereç ve yöntem: Ocak 2016-Aralık 2020 yıllarında 18-70 yaş arası opere edilen 390 hasta çalışmaya dahil edildi. Hasta kayıtları retrospektif olarak elektronik ortamdan taranarak kayıt edildi.
Bulgular: Morbid obezite olan 390 hastaya Laparoskopik sleeve gastrektomi (LSG) cerrahisi uygulandı. Hastaların 310’u (%78,1) kadın, 80’i (%21,9) erkek, yaş ortalamaları 42,1 (22-65) ve 42,9 (24-70) idi. LSG olan hastaların 22’sinde (%5,64) komplikasyon gözlendi. Hastaların 10’unda (%2,56) erken dönemde komplikasyon, 9’unda (%2,30) geç dönemde komplikasyon gelişirken, 3(%0,76)’ünde hem erken hem de geç dönemde komplikasyon geliştiği tespit edildi.
Erken dönem komplikasyonlar; Yedi (%1,8) hastada postoperatif erken dönem anostomoz kaçağı, 1 (%0,25) hastada kanama, 2 (%0,5) hastada atelektazi, 1 (%0,25) hastada dehidratasyon, 1 (%0,25) hastada karın içi koleksiyon,1 (%0,25) hastada plörozi tespit edildi. Kaçak hastalarına stent uygulandı, kanama gözlenen hasta opere edildi. Diğer hastalara medikal tedavi uygulandı.
Geç dönem komplikasyonlar; 5 (%1,28) hastada insisura angulariste reflüye sebeb olan minimal darlık, 4 (%1,02) hastada trokar yeri hernisi olduğu tespir edildi.
Erken ve geç komplikasyon; Erken dönemde kaçak nedeniyle stent uygulanan 3 (%0,76) hastada aynı zamanda geç dönem komplikasyonu da gelişti. Bu hastaların 1 (%0,25)‘inde stent sonrası geç pilor stenozu, 1 (%0,25)‘inde mide ülserleri ve birinde de 1 (%0,25) özofagokardial bileşkede darlık tespit edildi. Trokar yeri hernisi olan hastalar ve ciddi semptomlu insisura angularis darlığı olan hasta cerrahi olarak tedavi edilirken, diğer hastalar medikal tedavi uygulandı. Mortalite gözlenmedi.
Sonuç: Morbid obezite tedavisinde etkili bir yöntem olan LSG’nin erken ve geç dönemde gözlenebilecek ciddi komplikasyonları olabilir. Bu nedenle gerekli yoğun bakım koşulları ve stent gibi endoskopik girişimlerin hızlı ve güvenilir bir şekilde yapılabileceği merkezlerde opere edilmeleri daha güvenli olacağı kanısındayız.

Anahtar Kelimeler

• Laparoskopik sleeve gastrektomi
• kaçak
• stent
• komplikasyon

Kaynakça

1. 1. Cavin JB, Voitellier E, Cluzeaud F, Kapel N, Marmuse JP, Chevallier JM, et al. (2016) Malabsorption and intestinal adaptation after one anastomosis gastric bypass compared with Roux-en-Y gastric bypass in rats. Am J Physiol Gastrointest Liver Physiol 311(3): 492- 500
2. 2. Gagner M, Deitel M, Kalberer TL, Erickson AL, Crosby RD. (2009) The Second International Consensus Summit for Sleeve Gastrectomy, March 19-21, 2009. Surg Obes Relat Dis 5(4): 476-485.
3. 3. Van Rutte PW, Smulders JF, de Zoete JP, Nienhuijs SW. (2014) Outcomes of sleeve gastrectomy as a primary bariatric procedure. Br J Surg 101(6):661-8
4. 4.Chang SH, Stoll CR, Song J, Varela JE, Eagon CJ, Colditz GA. (2014) The Effectiveness and Risks of Bariatric Surgery An Updated Systematic Review and Meta-analysis, 2003-2012. JAMA Surg 149:275–87.
5. 5. Langer FB, Reza Hoda MA, Bohdjalian A, et al. (2005) Sleeve gastrectomy and gastric banding: Effects on plasma ghrelin levels. Obes Surg 15: 1024-9.
6. 6. Brethauer SA, Hammel JP, Schauer PR. (2009) Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis 5: 469-75.
7. 7. Kayar H, Utku S. (2013) The Disease of Our Age, Obesity and Its Treatment, Mersin Üniv. Sağlık bilim Derg. 6(2):1-8
8. 8. Lazzati A, Guy-Lachuer R, Delaunay V, et al. (2014) Bariatric surgery trends in France: 2005-2011. Surgery for Obesity and Related Diseases, 10(2):328-34

9. 9. Reames BN, Finks JF, Bacal D, et al. (2014) Changes in bariatric surgical procedure use in Michigan, 2006-2013. JAMA 312(9):959-61.
10. 10. Buchwald H, Avidor Y, Braunwald E, et al. (2004) Bariatric surgery: A systematic review and meta-analysis. J Am Med Assoc 292: 1724-37.
11. 11. Alkhaldi LK , Alsaffar NA , Alhamdan F , Almutairi R, Alipour MH, Al Haddad E, Alsabah S. (2019) Long-Term Outcomes After Laparoscopic Sleeve Gastrectomy İn Kuwait, Ann Saudi Med. 39(2): 100–103.
12. 12.Melissas J, Daskalakis M, Koukouraki S, et al. (2008) Sleeve gastrectomy-a “food limiting” operation. Obes Surg 18:1251-6.
13. 13. Angrisani L, Furbetta F, Doldi SB et al. (2003) Lab Band adjustable banding system. The Italian experience with 1863 patients operated in 6 years. Surg Endosc 17:409-12.
14. 14. Hamoui N, Anthone GJ, Kaufman HS, et al. (2006) Sleeve gastrectomy in the high-risk patient. Obes Surg. 16:1445-9.
15. 15. Consten EC, Gagner M, Pomp A, et al. (2004) Decreased bleeding after laparoscopic sleeve gastrectomy with or without duodenal switch for morbid obesity using a stapled buttressed absorbable polymer membrane. Obes Surg. 14(10):1360-6.
16. 16.Baker, R.S., Foote, J., Kemmeter, P., Brady, R., Vroegop, T. and Serveld, M. (2004) The Science of Stapling Leaks. Obesity Surgery, 14: 1290-1366
17. 17. Swinnen J, Eisendrath P, Rigaux J, Kahegeshe L, Lemmers A, Le Moine O, et al. (2011) Self-expandable metal stents for the treatment of benign upper GI leaks and perforations. Gastrointest Endosc 73: 890-899.
18. 18. Himpens J, Dapri G, Cadiere GB. (2009) Treatment of leaks after sleeve gastrectomy. Bariatric Times. Sep,.Available: http://bariatrictimes.com/treatment-of-leaks-after-sleeve-gastrectomy
19. 19. Simon F, Siciliano I, Gillet A, Castel B, Coffin B, Msika S. (2013) Gastric leak after laparoscopic sleeve gastrectomy: Early covered selfexpandable stent reduces healing time. Obes Surg 23: 687- 692.
20. 20. Shikora SA, Mahoney CB. (2015) Clinical utility of gastric staple line reinforcement (SLR) in gastrointestinal surgery: a meta-analysis. Obesity Surgery, 25(7):1133–41.
21. 21. Jossart GH. (2010) Complications of Sleeve Gastrectomy Bleeding and Prevention, Surg Laparosc Endosc Percutan Tech. 20(3):146–7.
22. 22. Molloy D, Kaloo PD, Cooper M, et al.( 2002) Laparoscopic entry: a literature review and analysis of techniques and complications of primary port entry, Aust NZJ Obstet Gynaecol. 42:246–54.
23. 23. Şampiyon JK, Williams M. (2003) Small bowel obstruction and internal hernias after laparoscopic Roux-en-Y gastric bypass, Obesity Surgery, 13(4):596– 600.
24. 24. Israelsson LA, Jonsson T. (1996) Incisional hernia after midline laparotomy: a prospective study.Euro J Surg. 162:125–9.
25. 25. Sørensen LT, Hemmingsen UB, Kirkeby LT, et al. 82005) Smoking Is a Risk Factor for Incisional Hernia, Arch Surg 140:119–23.
26. 26. Gislason H, Grønbech JE, Søreide O. (1995) Abdominal burst and incisional hernia after major gastrointestinal surgery—comparison of three closure techniques. Euro J Surg. 161(5):349–54
27. 27. Sugerman HJ, Kellum JM, Reines HD, et al. (1996) Morbidly obese patients have a greater risk of incisional hernia than steroid-dependent patients and lower recurrence with prefacial polypropylene mesh. Ben J Surg 171: 80–4.
28. 28. Guillou PJ, Donaldson DR, Hall TJ, et al. (1980) Vertical abdominal incisions - a choice? Br J Surg. 67: 395–9
29. 29. Coblijn UK , Raaff CA , van Wagensveld BA , van Tets WF , Castro SM.( 2016) Trocar Port Hernias After Bariatric Surgery, Obes Surg 26(3):546-51.
30. 30.Boza C, Salınas J, Salgado N. et al.( 2012) Laparoscopic sleeve gastrectomy as a stand-alone procedure for morbid obesity: report of 1,000 cases and 3-year follow-upObes Surg 22(6):866-71.
31. 31.Cottam D, Qureshi FG, Mattar SG, et al. (2006) Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity, Surg Endosc 20(6):859-63.
32. 32. Manos T , Nedelcu M , Cotirlet A , Eddbali I , Gagner M ,( 2017) Patrick Noel, How to treat stenosis after sleeve gastrectomy? Surg Obes Relat Dis 13(2):150-155
33. 33.Shnell M, Fismann S, Eldar S, Goitein D, Santo E. (2014) Balloon dilatation for symptomatic gastric sleeve stricture, Gastrointestinal Endoscopy, 79(3): 521-524