Abstract
Background
Recently, improvised variants of sleeve gastrectomy SG were reported as alternative bariatric options in patients suffering from both morbid obesity and GERD, including mainly additional anterior or posterior fundoplication over a partially sleeved stomach.
Methods
We present the case of a 29-year-old male patient with a body mass index (BMI) of 46.2 kg/m2 underwent laparoscopic SG with concomitant posterior fundoplication: Nissen-SG (N-SG). At postoperative day (POD) 4, he presented with epigastric pain, nausea, and 40 °C fever. The abdomen was tender with signs of peritonitis. Explorative laparotomy displayed a massive gastric leak with generalized peritonitis. Peritoneal lavage was performed. the patient was transferred to our department for the management of persistent SGL.
Results
Initial management comprised total parenteral nutrition and wide-spectrum intravenous antibiotics. Three weeks later, the patient underwent laparoscopic exploration. As shown in the video, at least two leaks were individualized, including one, anterior, catheterized by the pigtails, and the other one, posterior, impossible to reach endoscopically (Fig. 1). A residual abscess, located between the left crus, the pancreas, and the upper edge of the spleen, was evacuated. Eventually, Roux-en-Y gastro-jejunostomy was performed
Conclusion
The adjunction of a posterior fundoplication may have contributed to the multiple and complex occurrence of SGL. Having an ill-vascularized redundant fundus may have increased ischemia of the GE junction. Moreover, it is more difficult to perform endoscopic treatment in a plicated and sleeved stomach as well.
Similar content being viewed by others
References
Rozier MD, Ghaferi AA, Rose AM, et al. Preferences for bariatric surgery: comparing surgeons and patients using a discrete choice experiment. Surg Obes Relat Dis. 2020;S1550–7289(20):30086–1.
Gu L, Fu R, Chen P, et al. In terms of nutrition, the most suitable method for bariatric surgery: laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass? A systematic review and meta-analysis. Obes Surg. 2020;30(5):2003–2014. https://doi.org/10.1007/s11695-020-04488-2
Sharara AI, Rustom LBO, Bou Daher H, et al. Prevalence of gastroesophageal reflux and risk factors for erosive esophagitis in obese patients considered for bariatric surgery. Dig Liver Dis. 2019;51:1375–9.
Gu L, Chen B, Du N, et al. Relationship between bariatric surgery and gastroesophageal reflux disease: a systematic review and meta-analysis. Obes Surg. 2019;29:4105–13.
Rebecchi F, Allaix ME, Patti MG, et al. Gastroesophageal reflux disease and morbid obesity: to sleeve or not to sleeve? World J Gastroenterol. 2017;23:2269–75.
Del Genio G, Tolone S, Gambardella C, et al. Sleeve gastrectomy and anterior fundoplication (D-SLEEVE) prevents gastroesophageal reflux in symptomatic GERD. Obes Surg. 2020;30(5):1642–1652. https://doi.org/10.1007/s11695-020-04427-1
Amor IB, Casanova V, Vanbiervliet G, et al. The Nissen-Sleeve (N-Sleeve): results of a cohort study. Obes Surg. 2020;14. https://doi.org/10.1007/s11695-020-04469-5
Nedelcu M, Manos T, Gagner M, et al. Cost analysis of leak after sleeve gastrectomy. Surg Endosc. 2017;31:4446–50.
Gagner M, Kemmeter P. Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review. Surg Endosc. 2020;34:396–407.
Lee WJ, Han ML, Ser KH, et al. Laparoscopic Nissen fundoplication with gastric plication as a potential treatment of morbidly obese patients with GERD, first experience and results. Obes Surg. 2014;24(9):1447–52. https://doi.org/10.1007/s11695-014-1223-0.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflicts of interest.
Statement of Informed Consent
Informed consent was obtained from all individual participants included in the study.
Statement of Human and Animal Rights
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic Supplementary Material
Rights and permissions
About this article
Cite this article
Chouillard, E., Chahine, E., D’Alessandro, A. et al. Roux-en-Y Gastro-jejunostomy for Complex Leak After the “Nissen” Variant of Sleeve Gastrectomy. OBES SURG 30, 3642–3644 (2020). https://doi.org/10.1007/s11695-020-04731-w
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-020-04731-w