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T-Tube Gastrostomy as a Novel Approach for Distal Staple Line Disruption after Sleeve Gastrectomy for Morbid Obesity: Case Report and Review of the Literature

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Abstract

Laparoscopic sleeve gastrectomy has recently become a feasible option in the management of morbid obesity. One of the most feared complications of this procedure is staple line disruption and leakage. There are, to our knowledge, few literature reports that try to explain the reasons and management of this rare but serious complication. We report a case of staple line disruption that was managed using a T-tube gastrostomy. A 50-year-old female, 2 weeks status post-sleeve gastrectomy in an outside facility, was admitted to the emergency room at Cleveland Clinic Florida with new onset of fever, abdominal pain, jaundice, hematemesis, and melena. A computed tomography scan of the abdomen revealed a large extravasation of contrast material parallel to the gastric sleeve. A diagnostic laparoscopy was performed that showed a distal and proximal disruption of the staple line. A T-tube gastrostomy with a large proximal and distal limb was placed into the most distal area of disruption. After thorough over sewing and drainage of the proximal site and T-tube, a feeding jejunostomy was placed. The T-tube permitted to control the leak and to have a controlled fistula. Four weeks postoperatively, the T-tube was removed after the patient had a negative Gastrografin study and tolerated oral fluids with a clamped T-tube. The long-term recovery and follow-up were uneventful. T-tube gastrostomy appears to be a safe and feasible treatment option for staple line disruption after vertical sleeve gastrectomy. Early detection and drainage remain the most important principles to manage this type of complication.

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References

  1. DeMaria EJ. Bariatric surgery for morbid obesity. N Engl J Med. 2007;357(11):1158–60.

    Article  Google Scholar 

  2. Deitel M, Crosby RD, Gagner M. The First International Consensus Summit for Sleeve Gastrectomy (SG), New York City, October 25–27, 2007. Obes Surg. 2008;18(5):487–96.

    Article  PubMed  Google Scholar 

  3. Moy J, Pomp A, Dakin G, et al. Laparoscopic sleeve gastrectomy for morbid obesity. Am J Surg. 2008;196(5):e56–9.

    Article  PubMed  Google Scholar 

  4. Tucker ON, Szomstein S, Rosenthal RJ. Indications for sleeve gastrectomy as a primary procedure for weight loss in the morbidly obese. J Gastrointest Surg. 2008;12(4):662–7.

    Article  CAS  PubMed  Google Scholar 

  5. Baltasar A, Serra C, Perez N, et al. Laparoscopic sleeve gastrectomy: a multipurpose bariatric operation. Obes Surg. 2005;15(8):1124–8.

    Article  PubMed  Google Scholar 

  6. Fuks D, Verhaeghe P, Brehant O, et al. Results of laparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity. Surgery. 2009;145(1):106–13.

    Article  PubMed  Google Scholar 

  7. Lalor PF, Tucker ON, Szomstein S, et al. Complications after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2008;4(1):33–8.

    Article  PubMed  Google Scholar 

  8. Baltasar A, Bou R, Bengochea M, et al. Use of a Roux limb to correct esophagogastric junction fistulas after sleeve gastrectomy. Obes Surg. 2007;17(10):1408–10.

    Article  PubMed  Google Scholar 

  9. Serra C, Baltasar A, Andreo L, et al. Treatment of gastric leaks with coated self-expanding stents after sleeve gastrectomy. Obes Surg. 2007;17(7):866–72.

    Article  PubMed  Google Scholar 

  10. Ghanbari A, Mannur K. An alternative management of sleeve gastrectomy complications. Br J Surg. 2008;95(Supplement 7):19.

    Google Scholar 

  11. Papavramidis TS, Kotzampassi K, Kotidis E, et al. Endoscopic fibrin sealing of gastrocutaneous fistulas after sleeve gastrectomy and biliopancreatic diversion with duodenal switch. J Gastroenterol Hepatol. 2008;23(12):1802–5.

    Article  PubMed  Google Scholar 

  12. Chen B, Kiriakopoulos A, Tsakayannis D, et al. Reinforcement does not necessarily reduce the rate of staple line leaks after sleeve gastrectomy. A review of the literature and clinical experiences. Obes Surg. 2009;19(2):166–72.

    Article  PubMed  Google Scholar 

  13. Assalia A, Ueda K, Matteotti R, et al. Staple-line reinforcement with bovine pericardium in laparoscopic sleeve gastrectomy: experimental comparative study in pigs. Obes Surg. 2007;17(2):222–8.

    Article  PubMed  Google Scholar 

  14. Consten EC, Gagner M, Pomp A, et al. Decreased bleeding after laparoscopic sleeve gastrectomy with or without duodenal switch for morbid obesity using a stapled buttressed absorbable polymer membrane. Obes Surg. 2004;14(10):1360–6.

    Article  PubMed  Google Scholar 

  15. Kasalicky M, Michalsky D, Housova J, et al. Laparoscopic sleeve gastrectomy without an over-sewing of the staple line. Obes Surg. 2008;18(10):1257–62.

    Article  PubMed  Google Scholar 

  16. Bernante P, Foletto M, Busetto L, et al. Feasibility of laparoscopic sleeve gastrectomy as a revision procedure for prior laparoscopic gastric banding. Obes Surg. 2006;16(10):1327–30.

    Article  PubMed  Google Scholar 

  17. Mognol P, Chosidow D, Marmuse JP. Laparoscopic sleeve gastrectomy (LSG): review of a new bariatric procedure and initial results. Surg Technol Int. 2006;15:47–52.

    PubMed  Google Scholar 

  18. Moon Han S, Kim WW, Oh JH. Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obesity Surgery. 2005;15(10):1469–75.

    Article  PubMed  Google Scholar 

  19. Givon-Madhala O, Spector R, Wasserberg N, et al. Technical aspects of laparoscopic sleeve gastrectomy in 25 morbidly obese patients. Obesity Surgery. 2007;17(6):722–7. [see comment][erratum appears in Obes Surg. 2007 Jul;17(7):996].

    Article  PubMed  Google Scholar 

  20. Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006;20(6):859–63.

    Article  CAS  PubMed  Google Scholar 

  21. Linden PA, Bueno R, Mentzer SJ, et al. Modified T-tube repair of delayed esophageal perforation results in a low mortality rate similar to that seen with acute perforations. Ann Thorac Surg. 2007;83(3):1129–33.

    Article  PubMed  Google Scholar 

  22. Maluf-Filho F, Lima MS, Hondo F, et al. Endoscopic placement of a "plug" made of acellular biomaterial: a new technique for the repair of gastric leak after Roux-en-Y gastric bypass. Arq Gastroenterol. 2008;45(3):208–11.

    Article  PubMed  Google Scholar 

  23. Tucker ON, Szomstein S, Rosenthal R. Laparoscopic management of chronic pouch fistula after a leak following staple line dehiscence after laparoscopic revision of a dilated pouch following Roux-en-Y gastric bypass. Obes Surg. 2008;18(2):228–32.

    Article  PubMed  Google Scholar 

  24. Kowalski C, Kastuar S, Mehta V, et al. Endoscopic injection of fibrin sealant in repair of gastrojejunostomy leak after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2007;3(4):438–42.

    Article  PubMed  Google Scholar 

  25. Schweitzer MA, Lidor A, Magnuson TH. A zero leak rate in 251 consecutive laparoscopic gastric bypass operations using a two-layer gastrojejunostomy technique. J Laparoendosc Adv Surg Tech A. 2006;16(2):83–7.

    Article  PubMed  Google Scholar 

  26. Carrasquilla C, English WJ, Esposito P, et al. Total stapled, total intra-abdominal (TSTI) laparoscopic Roux-en-Y gastric bypass: one leak in 1,000 cases. Obes Surg. 2004;14(5):613–7.

    Article  PubMed  Google Scholar 

  27. Sapala JA, Wood MH, Schuhknecht MP. Anastomotic leak prophylaxis using a vapor-heated fibrin sealant: report on 738 gastric bypass patients. Obes Surg. 2004;14(1):35–42.

    Article  PubMed  Google Scholar 

  28. Shikora SA, Kim JJ, Tarnoff ME. Reinforcing gastric staple-lines with bovine pericardial strips may decrease the likelihood of gastric leak after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13(1):37–44.

    Article  PubMed  Google Scholar 

  29. Andrade-Alegre R. Surgical treatment of traumatic esophageal perforations: analysis of 10 cases. Clinics (Sao Paulo). 2005;60(5):375–80.

    Google Scholar 

  30. Vrouenraets BC, Been HD, Brouwer-Mladin R, et al. Esophageal perforation associated with cervical spine surgery: report of two cases and review of the literature. Dig Surg. 2004;21(3):246–9.

    Article  CAS  PubMed  Google Scholar 

  31. Zhang Y, Lu P. Discussion on diagnosis and treatment of 12 patients with intrathoracic oesophageal perforation caused by foreign body. J Clin Otorhinolaryngol. 2004;18(3):145–6.

    Google Scholar 

  32. Port JL, Kent MS, Korst RJ, et al. Thoracic esophageal perforations: a decade of experience. Ann Thorac Surg. 2003;75(4):1071–4.

    Article  PubMed  Google Scholar 

  33. Carmon M, Seror D, Udassin R, et al. Feeding jejunostomy for post-operative nutritional support. Clin Nutr. 1991;10(5):298–301.

    Article  CAS  PubMed  Google Scholar 

  34. Han-Geurts IJ, Lim A, Stijnen T, et al. Laparoscopic feeding jejunostomy: a systematic review. Surg Endosc. 2005;19(7):951–7.

    Article  CAS  PubMed  Google Scholar 

  35. Lee S, Carmody B, Wolfe L, et al. Effect of location and speed of diagnosis on anastomotic leak outcomes in 3828 gastric bypass cases. J Gastrointest Surg. 2007;11(6):708–13.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. The Bariatric and Metabolic Institute, Section of Minimally Invasive and Endoscopic Surgery, Cleveland Clinic Florida, Weston, FL, 33331, USA

    Ismael Court, Aaron Wilson, Peter Benotti, Samuel Szomstein & Raul J. Rosenthal

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  1. Ismael Court
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  2. Aaron Wilson
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  3. Peter Benotti
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  4. Samuel Szomstein
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  5. Raul J. Rosenthal
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Correspondence to Raul J. Rosenthal.

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Court, I., Wilson, A., Benotti, P. et al. T-Tube Gastrostomy as a Novel Approach for Distal Staple Line Disruption after Sleeve Gastrectomy for Morbid Obesity: Case Report and Review of the Literature. OBES SURG 20, 519–522 (2010). https://doi.org/10.1007/s11695-009-9898-3

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