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Obesity Surgery

, Volume 23, Issue 5, pp 676–686 | Cite as

Sleeve Gastrectomy Severe Complications: Is It Always a Reasonable Surgical Option?

  • David Moszkowicz
  • Roberto Arienzo
  • Idir Khettab
  • Gabriel Rahmi
  • Franck Zinzindohoué
  • Anne Berger
  • Jean-Marc Chevallier
Original Contributions

Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) is widely adopted but exposes serious complications.

Methods

A retrospective database analysis was done to study LSG staple line complications in a tertiary referral university center with surgical ICU experienced in treatment of morbid obesity and complications. Twenty-two consecutive patients were referred between January 2004 and February 2012 with postoperative gastric leak or stenosis after LSG. Interventions consisted in the control of intra-abdominal and general sepsis; restoration of staple line continuity or revision of LSG; nutritional support; treatment of associated complications. Main outcome measures concerned success rates of therapeutic strategies, morbidity and mortality rates, LOS, and time to cure.

Results

Thirteen patients (59 %) were referred after failure of reoperation (seven fistula repairs were attempted). Three patients received emergency surgery in our center with transorificial intubation and jejunostomy formation. An endoscopic stent was tried in nine patients but failed in 84.6 % of cases within 20 days (1–161). Seven patients (32 %) necessitated total gastrectomy within 217 days (0–1,915 days) for conservative treatment failure. Procedures under general anesthesia were required in 41 % of cases, organ failure was found in 55 % of cases, and central venous device infection in 40 %. Mortality rate was 4.5 % (n = 1). Patients with unfavorable evolution of LSG complications (death or additional gastrectomy) had more previous bariatric procedure (82 % vs. 18 %, p = 0.003). Median time to cure was 310 days (9–546 days).

Conclusions

LSG exposes severe complications occurring in patients with benign condition. Endoscopic stents entail high failure rate. Total gastrectomy is required in one third of the cases.

Keywords

Bariatric surgery Gastric leak Gastric stenosis Laparoscopy Morbid obesity Revisional Surgery Sleeve gastrectomy 

Notes

Conflicts of Interest

None.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • David Moszkowicz
    • 1
    • 2
  • Roberto Arienzo
    • 1
    • 2
  • Idir Khettab
    • 1
    • 3
  • Gabriel Rahmi
    • 1
    • 4
  • Franck Zinzindohoué
    • 1
    • 2
  • Anne Berger
    • 1
    • 2
  • Jean-Marc Chevallier
    • 1
    • 2
  1. 1.Assistance Publique-Hôpitaux de ParisUniversity Paris 5ParisFrance
  2. 2.Department of Digestive SurgeryHôpital Européen Georges PompidouParis cedex 15France
  3. 3.Department of RadiologyHôpital Européen Georges PompidouParisFrance
  4. 4.Department of Gastroenterology and EndoscopyHôpital Européen Georges PompidouParisFrance

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