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LSG: Complications—Diagnosis and Management

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Obesity, Bariatric and Metabolic Surgery

Abstract

Laparoscopic Sleeve Gastrectomy (LSG) is currently one of the most common obesity procedures performed worldwide. Initially described as the first component of more complex procedures, it is now accepted as a stand-alone intervention. Although theoretically a simple procedure, it can be followed by life-threatening complications. Prevention and management of these complications require the adoption of a standardized perioperative protocol and timely interpretation of abnormal postoperative findings. Deviation from the normal postoperative clinical course or abnormal blood tests (elevation of inflammatory parameters or a drop in hemoglobin) should raise the suspicion of complications. An integrated teamwork approach is necessary to interpret abnormal signs, blood or radiology results and to instigate prompt management. Diagnostic laparoscopy yields highly specific results.

Postoperative complications can present either early or late. Early complications include staple line leakage and bleeding. Endoscopic stenting and/or surgical revision are usually required to manage leakage. Haemodynamic instability secondary to staple line bleeding necessitates surgical revision. Late postoperative complications include leakage (which may present as free intra-peritoneal leakage, abscess formation or development of fistula), sleeve stenosis (which may be associated with other complications including leakage) or perigastric hematoma. Late leakage may respond to endoscopic stenting, drainage or conversion to Roux-en-Y gastric bypass (RYGB). Stenosis can be managed with dilatation and/or conversion to RYGB. Malnutrition after LSG is another serious complication.

This chapter will analyze early and late post-LSG complications, highlighting our standardized perioperative protocol to prevent, diagnose and manage complications in a timely manner. Relevant algorithms are also discussed.

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Authors and Affiliations

  1. Department Metabolic Surgery, Sana Klinikum Offenbach, Offenbach am Main, Germany

    Rudolf A. Weiner MD, PhD

  2. Department for Surgery of Obesity and Metabolic Disorders (Center of Excellence), Offenbach am Main, Germany

    Rudolf A. Weiner MD, PhD

  3. Department for Surgery of Obesity and Metabolic Disorders (Center of Excellence), Sana Klinikum Offenbach, Offenbach am Main, Germany

    Islam A. El-Sayes MD

  4. Department of General, Visceral and Minimally Invasive Surgery, Nordwest Hospital, Frankfurt am Main, Germany

    Sylvia R. Weiner MD

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  1. Rudolf A. Weiner MD, PhD
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  2. Islam A. El-Sayes MD
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  3. Sylvia R. Weiner MD
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Correspondence to Rudolf A. Weiner MD, PhD .

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  1. Homerton University Hospital, London, United Kingdom

    Sanjay Agrawal

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Weiner, R.A., El-Sayes, I.A., Weiner, S.R. (2016). LSG: Complications—Diagnosis and Management. In: Agrawal, S. (eds) Obesity, Bariatric and Metabolic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-04343-2_27

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  • DOI: https://doi.org/10.1007/978-3-319-04343-2_27

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