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Perioperative hemorrhagic complications after laparoscopic sleeve gastrectomy: four-year experience of a bariatric center of excellence

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Abstract

Background

Bleeding and gastric fistula are the most common postoperative complications after laparoscopic sleeve gastrectomy (LSG). The long stapler line represents the most frequent source of bleeding, which ranges between 0 and 20%. The aim of this retrospective study was to analyze the 4-year experience of a high-volume center with respect to the prevention and management of perioperative LSG bleeding.

Methods

The prospectively maintained database from June 2012 to June 2016 was reviewed. Outcomes, especially perioperative bleeding (until patient discharge), its management, and follow-ups, were analyzed.

Results

Out of 870 LSG (603 females, 267 males), 31 cases (3.5%) of postoperative complications were registered: bleeding was the most frequent complication (1.9%). Hemoperitoneum was managed laparoscopically in 9/17 patients (52.9%) with only one conversion to laparotomy (11.1%). Conservative treatment successfully controlled bleeding in 8/17 patients (47.1%). However, four patients (50%) developed an infected hematoma; two of them were treated conservatively with a CT-guided drainage, and the other two were complicated by late gastric leak treated laparoscopically. No mortalities occurred in the investigated cases.

Conclusions

In a high-volume center, the expected incidence of bleeding after LSG is 1.7% even after the adoption of all preventive strategies. The intraoperative protocol for detecting silent bleeding was effective, and no cases of bleeding were observed since its application. Our findings showed that the conservative management of postoperative bleeding should be considered as a high-risk condition for late leakage.

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Authors and Affiliations

  1. Division of General Surgery and Bariatric Center of Excellence, Department of Medico-Surgical Sciences and Biotechnologies, La Sapienza University of Rome, Via F. Faggiana 1668, 04100, Latina, Italy

    Francesco De Angelis, Mohamed Abdelgawad, Mario Rizzello & Gianfranco Silecchia

  2. Faculty of Medicine, Gastroenterology Surgical Center (GEC), Mansoura University, Mansoura, Egypt

    Mohamed Abdelgawad

  3. Unit of Anesthesia and ICU, Department of Medico-Surgical Sciences and Biotechnologies, La Sapienza University of Rome, Via F. Faggiana 1668, 04100, Latina, Italy

    Consalvo Mattia

Authors
  1. Francesco De Angelis
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  2. Mohamed Abdelgawad
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  3. Mario Rizzello
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  4. Consalvo Mattia
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  5. Gianfranco Silecchia
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Corresponding author

Correspondence to Gianfranco Silecchia.

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Disclosures

Drs. Francesco De Angelis, Mohamed Abdelgawad, Mario Rizzello, Consalvo Mattia, and Gianfranco Silecchia have no conflicts of interest or financial ties to disclose.

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De Angelis, F., Abdelgawad, M., Rizzello, M. et al. Perioperative hemorrhagic complications after laparoscopic sleeve gastrectomy: four-year experience of a bariatric center of excellence. Surg Endosc 31, 3547–3551 (2017). https://doi.org/10.1007/s00464-016-5383-y

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  • DOI: https://doi.org/10.1007/s00464-016-5383-y

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