Updates in Surgery

, Volume 69, Issue 4, pp 541–544 | Cite as

The visualization of gastro-esophageal junction vascular supply during a laparoscopic sleeve gastrectomy. Role of a new device

  • Mario Musella
  • Marco Milone
  • Paolo Bianco
  • Francesco Milone
Technical Note
First Online:
Received:
Accepted:

Abstract

Leaks arising at the level of gastro-esophageal junction remain a major complication in patients who undergo a laparoscopic sleeve gastrectomy. Besides technical pitfalls, these fistulas are mainly attributable to tissue ischemia following the preparation of the gastric sleeve, explained by the irregular vascularization often present in the area of the gastro-esophageal junction. This video presentation shows how, the utilization of a new model of bougie can be of help in preventing a leak, allowing a better visualization of the particular vascular anatomy present at the level of the gastro-esophageal junction area. Currently, 25/334 (18 F–7 M) (7.4%) patients, who underwent a laparoscopic sleeve gastrectomy at our institution, were operated on using this new model of bougie. No leaks have been so far reported.

Keywords

Sleeve gastrectomy Gastroesophageal junction Vascular supply Visualization Double lumen bougie Postoperative leaks 
This is a preview of subscription content, log in to check access.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

A tested gastric double lumen tube currently available on the market was used. It has to be remarked that all LSG procedures performed by authors, and involving human participants, were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

An informed consent, according to the Italian Society of Bariatric and Metabolic Surgery (SICOB) guidelines, was obtained from all patients who underwent a LSG procedure performed by anyone of the authors of this study during these years.

Supplementary material

13304_2017_479_MOESM1_ESM.mp4 (212.3 mb)
Supplementary material 1 (MP4 217413 kb)
13304_2017_479_MOESM2_ESM.doc (29 kb)
Supplementary material 2 (DOC 29 kb)

References

  1. 1.
    Bray GA, Frühbeck G, Ryan DH, Wilding JP (2016) Management of obesity. Lancet. doi: 10.1016/S0140-6736(16)00271-3 PubMedCentralGoogle Scholar
  2. 2.
    http://www.sicob.org. Accessed 28 June 2016
  3. 3.
    Musella M, Milone M, Bianco P, Maietta P, Galloro G (2016) Acute leaks following laparoscopic sleeve gastrectomy: early surgical repair according to a management algorithm. J Laparoendosc Adv Surg Tech A 26(2):85–91CrossRefPubMedGoogle Scholar
  4. 4.
    Aurora AL, Khaitan L, Saber AA (2012) Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc 26:1509–1515CrossRefPubMedGoogle Scholar
  5. 5.
    Ferrer-Marquez M, Belda-Lozano R, Ferrer-Ayza M (2012) Technical controversies in laparoscopic sleeve gastrectomy. Obes Surg 22:182–187CrossRefPubMedGoogle Scholar
  6. 6.
    Milone M, Di Minno MN, Musella M, Maietta P, Iaccarino V, Barone G, Milone F (2013) Computed tomography findings of pneumatosis and portomesenteric venous gas in acute bowel ischemia. World J Gastroenterol 19:6579–6584CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Perez M, Brunaud L, Kedaifa S, Guillotin C, Gerardin A, Quilliot D, Grosdidier G, Reibel N (2014) Does anatomy explain the origin of a leak after sleeve gastrectomy? Obes Surg 24(10):1717–1723CrossRefPubMedGoogle Scholar
  8. 8.
    Bellanger DE, Greenway FL (2011) Laparoscopic sleeve gastrectomy, 529 cases without a leak: short-term results and technical considerations. Obes Surg 21(2):146–150CrossRefPubMedGoogle Scholar
  9. 9.
    Musella M, Milone M, Maietta P, Bianco P, Pisapia A, Gaudioso D (2014) Laparoscopic sleeve gastrectomy: efficacy of fibrin sealant in reducing postoperative bleeding. A randomized controlled trial. Updates Surg 66(3):197–201CrossRefPubMedGoogle Scholar
  10. 10.
    Musella M, Lombardi S, Caiazzo P, Milone F, Di Palma R, de Franciscis S, Jovino R (2003) Video-assisted surgery of the thyroid: outlines of the technique and analysis of the results. Ann Ital Chir 74(1):3–5PubMedGoogle Scholar
  11. 11.
    Angrisani L, Santonicola A, Iovino P, Formisano G, Buchwald H, Scopinaro N (2015) Bariatric surgery worldwide 2013. Obes Surg 25(10):1822–1832CrossRefPubMedGoogle Scholar
  12. 12.
    Natoudi M, Theodorou D, Papalois A, Drymousis P, Alevizos L, Katsaragakis S, Zografos G, Leandros E, Menenakos E (2014) Does tissue ischemia actually contribute to leak after sleeve gastrectomy? An experimental study. Obes Surg 24(5):675–683CrossRefPubMedGoogle Scholar
  13. 13.
    Mion F, Tolone S, Garros A, Savarino E, Pelascini E, Robert M, Poncet G, Valette PJ, Marjoux S, Docimo L, Roman S (2016) High-resolution impedance manometry after sleeve gastrectomy: increased intragastric pressure and reflux are frequent events. Obes Surg 26:2449–2456CrossRefPubMedGoogle Scholar
  14. 14.
    Del Genio G, Tolone S, Limongelli P, Brusciano L, D’Alessandro A, Docimo G, Rossetti G, Silecchia G, Iannelli A, del Genio A, del Genio F, Docimo L (2014) Sleeve gastrectomy and development of “de novo” gastroesophageal reflux. Obes Surg 24(1):71–77CrossRefPubMedGoogle Scholar
  15. 15.
    Parikh M, Issa R, McCrillis A, Saunders JK, Ude-Welcome A, Gagner M (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
  16. 16.
    Baker RS, Foote J, Kemmeter P, Brady R, Vroegop T, Serveld M (2004) The science of stapling and leaks. Obes Surg 14:1290–1298CrossRefPubMedGoogle Scholar
  17. 17.
    Al-Shoek I, Hussain A, El-Hasani S (2015) Does anatomy explain the origin of a leak after sleeve gastrectomy. Obes Surg 25(4):713–714CrossRefPubMedGoogle Scholar

Copyright information

© Italian Society of Surgery (SIC) 2017

Authors and Affiliations

  1. 1.Advanced Biomedical Sciences Department, AOU “Federico II”“Federico II” UniversityNaplesItaly

Personalised recommendations