Advertisement

Der Chirurg

, Volume 89, Issue 12, pp 969–976 | Cite as

Endoskopisches Komplikationsmanagement nach Schlauchmagenbildung

  • C. Stier
  • C. Corteville
Leitthema
  • 192 Downloads

Zusammenfassung

Die Schlauchmagenbildung („sleeve gastrectomy“, SG) ist gegenwärtig weltweit das am häufigsten durchgeführte adipositaschirurgische Operationsverfahren. Die gefürchtete operationsimmanente Komplikation dabei ist eine Leckage der Klammernahtreihe, die sehr schwierig zu therapieren ist und oft persistiert. In diesem Beitrag sollen die endoskopischen Therapieoptionen bei Komplikationen nach einer Schlauchmagenbildung, insbesondere die Therapie der Schlauchmagenleckage dargestellt werden. Dabei sind das Verständnis der Pathophysiologie der auftretenden Komplikation sowie die exakte chirurgische Kenntnis des Operationsverfahrens wesentliche Voraussetzungen für die erfolgreiche Therapie. Die eigentliche endoskopische Verfahrenswahl richtet sich dann pragmatisch nach der Ausstattung und den Möglichkeiten der jeweiligen Endoskopieeinheit und den Fertigkeiten des ausführenden Endoskopikers. Aktuell scheint die interne Drainage am zielführendsten zu sein.

Schlüsselwörter

Leckage Intraluminale Druckverhältnisse Stentbehandlung Intraluminale Drainage Endo-Vac-Behandlung 

Endoscopic management of complications after laparoscopic sleeve gastrectomy

Abstract

Laparoscopic sleeve gastrectomy (SG) is currently the most commonly performed standalone bariatric procedure worldwide. Gastric staple line leakage is the feared immanent complication of the operation, which is difficult to treat and often persists. This article presents the endoscopic treatment options for complications after laparoscopic SG, particularly the treatment of gastric staple line leakage. Most important for a successful treatment is the understanding of the underlying pathophysiological causes, the exact surgical comprehension of the procedure and advanced endoscopic skills. The choice of endoscopic intervention depends on the available strategies as well as on the skills of the executing endoscopist. Currently, internal drainage seems to be the most expedient method.

Keywords

Leakage Intraluminal pressure relations Stent treatment Intraluminal drainage Endo-vac treatment 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

C. Stier und C. Corteville geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Gagner M, Hutchinson C, Rosenthal RJ (2016) Fifth International Consensus Conference: status of sleeve gastrectomy. Surg Obes Relat Dis 12(49):750–756CrossRefPubMedGoogle Scholar
  2. 2.
    Fuks D, Verhaeghe P, Brehant O et al (2009) Results of laparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity. Surgery 145:106–113CrossRefPubMedGoogle Scholar
  3. 3.
    Yehoshua RD, Eidelman LA, Stein M et al (2008) Laparoscopic sleeve gastrectomy – volume and pressure assessment. Obes Surg 18(9):1083–1008CrossRefPubMedGoogle Scholar
  4. 4.
    Ren CJ, Patterson E, Gagner M (2000) Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients. Obes Surg 16(6):514–523CrossRefGoogle Scholar
  5. 5.
    De Cespel J, Burpee S, Jossart G et al (2001) Laparoscopic biliopancreatic diversion with a duodenal switch for morbid obesity: a feasibility study in pigs. J Laparoendosc Adv Surg Tech A 11(2):79–83CrossRefGoogle Scholar
  6. 6.
    Baltasar A, Bou R, Miró J et al (2002) Laparoscopic biliopancreatic diversion with duodenal switch: technique and initial experience. Obes Surg 12(2):245–248CrossRefPubMedGoogle Scholar
  7. 7.
    Weiner RA, Blanco-Engert R, Weiner S et al (2004) Laparoscopic biliopancreatic diversion with duodenal switch: three different duodeno-ileal anastomotic techniques and initial experience. Obes Surg 14(3):334–340CrossRefPubMedGoogle Scholar
  8. 8.
    Feng JJ, Gagner M (2002) Laparoscopic biliopancreatic diversion with duodenal switch. Semin Laparosc Surg 9(2):125–129CrossRefPubMedGoogle Scholar
  9. 9.
    Dapri G, Cadière GB, Himpens J (2011) Superobese and super-superobese patients: 2‑step laparoscopic duodenal switch. Surg Obes Relat Dis 7(6):703–708CrossRefPubMedGoogle Scholar
  10. 10.
    Milone L, Strong V, Gagner M (2005) Laparoscopic sleeve gastrectomy is superior to endoscopic intragastric balloon as a first stage procedure for super-obese patients (BMI > or = 50). Obes Surg 15(5):612–617CrossRefPubMedGoogle Scholar
  11. 11.
    Silecchia G, Boru C, Pecchia A et al (2006) Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg 16(99):1138–1144CrossRefPubMedGoogle Scholar
  12. 12.
    Mongol P, Chosidow D, Marmuse JP (2005) Laparoscopic sleeve gastrectomy as an initial bariatric operation for high-risk patients: initial results in 10 patients. Obes Surg 15(7):1030–1033CrossRefGoogle Scholar
  13. 13.
    Batasar A, Serra C, Pérez N (2005) Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg 15(8):1124–1128CrossRefGoogle Scholar
  14. 14.
    Han MS, Kim WW, Oh JH (2005) Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg 15(10):1469–1475CrossRefGoogle Scholar
  15. 15.
    Catheline JM, Cohen R, Khochtali I et al (2006) Treatment of super super morbid obesity by sleeve gastrectomy. Presse Med 35(3):383–387CrossRefPubMedGoogle Scholar
  16. 16.
    Deitel M, Crosby RD, Gagner M (2008) The First International Consensus Summit for sleeve gastrectomy (SG), New York City, October 25–27, 2007. Obes Surg 18(5):487–496CrossRefPubMedGoogle Scholar
  17. 17.
    Gagner M, Deitel M, Kalberer DM et al (2009) The Second International Consensus Summit for sleeve gastrectomy, March 19–21, 2009. Surg Obes Relat Dis 5(4):476–485CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Rosenthal RJ, International Sleeve Gastrectomy Expert Panel (2012) International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of > 12,000 cases. Surg Obes Relat Dis 8(1):8–19CrossRefPubMedGoogle Scholar
  19. 19.
    Gagner M, Deitel M, Erickson AL et al (2013) Survey on laparoscopic sleeve gastrectomy (LSG) at the Fourth International Consensus Summit on Sleeve Gastrectomy. Obes Surg 23(12):2013–2017CrossRefPubMedGoogle Scholar
  20. 20.
    Samakar K, McKenzie TJ, Tavakkoli A et al (2016) The effect of laparoscopic sleeve gastrectomy with concomitant hiatal hernia repair on gastroesophageal reflux disease in the morbidly obese. Obes Surg 26(19):61–66CrossRefPubMedGoogle Scholar
  21. 21.
    Melissas J, Braghetto I, Molina JC et al (2015) Gastroesophageal reflux disease and sleeve gastrectomy. Obes Surg 25(12):2430–2435CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Stenard F, Iannelli A (2015) Laparoscopic sleeve gastrectomy and gastroesophageal reflux. World J Gastroenterol 21(36):10348–10357CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Stroh C, Köckerling F, Lange V et al (2016) Results of more the 11,800 sleeve gastrectomies. Data analysis of the German bariatric registry. Ann Surg 263(5):949–955CrossRefPubMedGoogle Scholar
  24. 24.
    Vargas EJ, Abu Dayyeh BK (2018) Keep calm under pressure: a paradigm shift in postsurgical leaks. Gastrointest Endosc 87(2):438–441CrossRefPubMedGoogle Scholar
  25. 25.
    Aurora AR, Khaitan L, Saber AA (2012) Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc 26(6):1509–1515CrossRefPubMedGoogle Scholar
  26. 26.
    Parikh M, Issa R, McCrillis A, Saunders JK et al (2013) Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg 257:231–237CrossRefPubMedGoogle Scholar
  27. 27.
    Berry R, Miyagawa T, Paskaranandavadivel N et al (2016) Functional physiology of the human terminal antrum defined by high-resolution electrical mapping and computational modeling. Am J Physiol Gastrointest Liver Physiol 311(5):G895–G902CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Gomes M, Ramacciotti E, Miranda F Jr et al (2009) Vascular flow of the gastric fundus after arterial devascularization: an experimental study. J Surg Res 152:128–134CrossRefPubMedGoogle Scholar
  29. 29.
    Saber AA, Azar N, Dekal M, Abdelbaki TN (2015) Computed tomographic scan mapping of gastric wall perfusion and clinical implications. Am J Surg 209:999–1006CrossRefPubMedGoogle Scholar
  30. 30.
    Natoudi M, Theodorou D, Papalois A, Drymousis P, Alevizos L, Katsaragakis S et al (2014) Does tissue ischemia actually contribute to leak after sleeve gastrectomy? An experimental study. Obes Surg 24:675–683CrossRefPubMedGoogle Scholar
  31. 31.
    Konca C, Yilmaz AA, Celik SU et al (2018) The effects of Bougie diameters on tissue oxygen levels after sleeve gastrectomy: a randomized experimental trial. Balkan Med J 35(3):245–249CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Lorenzo D, Guilbaud T, Gonzalez JM et al (2018) Endoscopic treatment of fistulas after sleeve gastrectomy: a comparison of internal drainage versus closure. Gastrointest Endosc 87:429–437CrossRefPubMedGoogle Scholar
  33. 33.
    Loske G, Müller C (2009) Endoscopic vacuum-assisted closure of upper intestinal anastomotic leaks. Gastrointest Endosc 69:601–602CrossRefPubMedGoogle Scholar
  34. 34.
    Schorsch T, Müller C, Loske G (2013) Endoscopic vacuum therapy of anastomotic leakage and iatrogenic perforation in the esophagus. Surg Endosc 27(6):2040–2045CrossRefPubMedGoogle Scholar
  35. 35.
    Kuehn F, Loske G, Schiffmann L et al (2017) Endoscopic vacuum therapy for various defects of the upper gastrointestinal tract. Surg Endosc 31(9):3449–3458CrossRefPubMedGoogle Scholar
  36. 36.
    Leeds SG, Burdick JS (2016) Management of gastric leaks after sleeve gastrectomy with endoluminal vacuum (E-Vac) therapy. Surg Obes Relat Dis 12:1278–1285CrossRefPubMedGoogle Scholar
  37. 37.
    Puli SR, Spofford SS, Thompson CC (2012) Use of self-expandable stents in the treatment of bariatric surgery leaks: a systematic review and meta-analysis. Gastrointest Endosc 75(2):287–293CrossRefPubMedGoogle Scholar
  38. 38.
    Garofalo F, Noreau-Nguyen M, Denis R et al (2017) Evolution of endoscopic treatment of sleeve gastrectomy leaks: from partially covered to long, fully covered stents. Surg Obes Relat Dis 13(6):925–932CrossRefPubMedGoogle Scholar
  39. 39.
    Moon T, Hong D, Chun HJ et al (2001) New approach to radial expansive force measurement of self expandable esophageal metal stents. Asiao J 47(6):646–650CrossRefGoogle Scholar
  40. 40.
    Donatelli G, Dumont JL, Pourcher G et al (2017) Pneumatic dilation for functional helix stenosis after sleeve gastrectomy: long-term follow-up. Surg Obes Relat Dis 13(6):943–950CrossRefPubMedGoogle Scholar
  41. 41.
    Parikh A, Alley JB, Perterson RM et al (2012) Management options for symptomatic stenosis after laparoscopic vertical sleeve gastrectomy in the morbidly obese. Surg Endosc 26(3):738–746CrossRefPubMedGoogle Scholar
  42. 42.
    Rebibo L, Hakim S, Dhahri A et al (2016) Gastric stenosis after laparoscopic sleeve gastrectomy: diagnosis and management. Obes Surg 25(5):995–1001CrossRefGoogle Scholar
  43. 43.
    Jurowich C, Germer CT, Seyfried F, Thalheimer A (2012) Metabolische Chirurgie. Chirurg 83(6):583–598.  https://doi.org/10.1007/s00104-011-2239-9 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Klinik für Allgemein‑, Viszeral‑, Gefäß- und KinderchirurgieUniversitätsklinik WürzburgWürzburgDeutschland
  2. 2.Medizinische Klinik und Poliklinik IUniversitätsklinik WürzburgWürzburgDeutschland

Personalised recommendations