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Laparoscopic Sleeve Gastrectomy: Early Complications

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Obesity, Bariatric and Metabolic Surgery

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Abstract

Laparoscopic sleeve gastrectomy (LSG) is currently one of the commonest obesity procedures performed worldwide. Initially described as the first component of more complex procedures, it is now accepted as a stand-alone intervention. Although theoretically a simple procedure, it can be followed by life-threatening complications. Prevention and management of these complications require the adoption of a standardized perioperative protocol and timely interpretation of abnormal postoperative findings. Deviation from the normal postoperative clinical course or abnormal blood tests (elevation of inflammatory parameters or decrease in hemoglobin) should raise the suspicion of complications. An integrated teamwork approach is necessary to interpret abnormal signs, blood or radiology results, and to instigate prompt management. Diagnostic laparoscopy yields highly specific results.

Postoperative complications can present either early or late. Early complications include staple line leakage and bleeding. Endoscopic stenting and/or surgical revision are usually required to manage staple line leakage. Hemodynamic instability secondary to staple line bleeding necessitates surgical revision. Late postoperative complications include leakage (which may present as free intraperitoneal leakage, abscess formation, or development of fistula), sleeve stenosis (which may be associated with other complications including leakage), or perigastric hematoma. Late leakage may respond to endoscopic stenting, drainage, or conversion to Roux-en-Y gastric bypass (RYGB). Stenosis can be managed with dilatation and/or conversion to RYGB. Malnutrition after LSG is another serious complication.

This chapter will analyze post-LSG complications within 30 days, highlighting the standardized perioperative protocol to prevent, diagnose, and manage complications in a timely manner. Relevant algorithms are also discussed.

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References

  1. Marceau P, Biron S, Bourque RA, Potvin M, Hould FS, Simard S. Biliopancreatic diversion with a new type of gastrectomy. Obes Surg. 1993;3(1):29–35. https://doi.org/10.1381/096089293765559728.

    Article  CAS  Google Scholar 

  2. Scopinaro N, Gianetta E, Civalleri D, Bonalumi U, Bachi V. Bilio-pancreatic bypass for obesity: II. Initial experience in man. Br J Surg. 1979;66(9):618–20. https://doi.org/10.1002/bjs.1800660906.

    Article  CAS  Google Scholar 

  3. Ren CJ, Patterson E, Gagner M. Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients. Obes Surg. 2000;10(6):514–24. https://doi.org/10.1381/096089200321593715.

    Article  CAS  Google Scholar 

  4. Hutter MM, Schirmer BD, Jones DB, Ko CY, Cohen ME, Merkow RP, et al. First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg. 2011;254(3):410–22. https://doi.org/10.1097/SLA.0b013e31822c9dac.

    Article  Google Scholar 

  5. Birkmeyer NJ, Dimick JB, Share D, Hawasli A, English WJ, Genaw J, et al. Hospital complication rates with bariatric surgery in Michigan. JAMA. 2010;304(4):435–42. https://doi.org/10.1001/jama.2010.1034.

    Article  CAS  Google Scholar 

  6. DeMaria EJ, Pate V, Warthen M, Winegar DA. Baseline data from American Society for Metabolic and bariatric surgery-designated bariatric surgery centers of excellence using the bariatric outcomes longitudinal database. Surg Obes Relat Dis. 2010;6(4):347–55. https://doi.org/10.1016/j.soard.2009.11.015.

    Article  Google Scholar 

  7. Weiner RA, El-Sayes IA, Theodoridou S, Weiner SR, Scheffel O. Early postoperative complications: incidence, management, and impact on length of hospital stay. A retrospective comparison between laparoscopic gastric bypass and sleeve gastrectomy. Obes Surg. 2013;23(12):2004–12. https://doi.org/10.1007/s11695-013-1022-z.

    Article  Google Scholar 

  8. Weiner R, Peterli R. Nodal points. In: Immenroth M, Brenner J, editors. Laparoscopic gastric sleeve, vol. 11. Springer, Operation Primer; 2012. p. 32–58.

    Google Scholar 

  9. Daskalakis M, Berdan Y, Theodoridou S, Weigand G, Weiner RA. Impact of surgeon experience and buttress material on postoperative complications after laparoscopic sleeve gastrectomy. Surg Endosc. 2011;25(1):88–97. https://doi.org/10.1007/s00464-010-1136-5.

    Article  Google Scholar 

  10. Aasheim ET. Wernicke encephalopathy after bariatric surgery: a systematic review. Ann Surg. 2008;248(5):714–20. https://doi.org/10.1097/SLA.0b013e3181884308.

    Article  CAS  Google Scholar 

  11. Sajid MS, Khatri K, Singh K, Sayegh M. Use of staple-line reinforcement in laparoscopic gastric bypass surgery: a meta-analysis. Surg Endosc. 2011;25(9):2884–91. https://doi.org/10.1007/s00464-011-1637-x.

    Article  CAS  Google Scholar 

  12. Aggarwal S, Bhattacharjee H, Misra MC. Practice of routine intraoperative leak test during laparoscopic sleeve gastrectomy should not be discarded. Surg Obes Relat Dis. 2011;7(5):e24–5. https://doi.org/10.1016/j.soard.2011.03.013.

    Article  Google Scholar 

  13. Ferrer-Márquez M, Belda-Lozano R, Ferrer-Ayza M. Technical controversies in laparoscopic sleeve gastrectomy. Obes Surg. 2012;22(1):182–7. https://doi.org/10.1007/s11695-011-0492-0.

    Article  Google Scholar 

  14. Diamantis T, Alexandrou A, Pikoulis E, Diamantis D, Griniatsos J, Felekouras E, et al. Laparoscopic sleeve gastrectomy for morbid obesity with intra-operative endoscopic guidance. Immediate peri-operative and 1-year results after 25 patients. Obes Surg. 2010;20(8):1164–70. https://doi.org/10.1007/s11695-010-0176-1.

    Article  CAS  Google Scholar 

  15. Frezza EE, Barton A, Herbert H, Wachtel MS. Laparoscopic sleeve gastrectomy with endoscopic guidance in morbid obesity. Surg Obes Relat Dis. 2008;4(5):575–80. https://doi.org/10.1016/j.soard.2007.12.013.

    Article  Google Scholar 

  16. Casella G, Soricelli E, Rizzello M, Trentino P, Fiocca F, Fantini A, et al. Nonsurgical treatment of staple line leaks after laparoscopic sleeve gastrectomy. Obes Surg. 2009;19(7):821–6. https://doi.org/10.1007/s11695-009-9840-8.

    Article  CAS  Google Scholar 

  17. McCarty TM, Arnold DT, Lamont JP, Fisher TL, Kuhn JA. Optimizing outcomes in bariatric surgery: outpatient laparoscopic gastric bypass. Ann Surg. 2005;242(4):494–501. https://doi.org/10.1097/01.sla.0000183354.66073.4c.

    Article  Google Scholar 

  18. Lancaster RT, Hutter MM. Bands and bypasses: 30-day morbidity and mortality of bariatric surgical procedures as assessed by prospective, multi-center, risk-adjusted ACS-NSQIP data. Surg Endosc. 2008;22(12):2554–63. https://doi.org/10.1007/s00464-008-0074-y.

    Article  Google Scholar 

  19. Dallal RM, Datta T, Braitman LE. Medicare and medicaid status predicts prolonged length of stay after bariatric surgery. Surg Obes Relat Dis. 2007;3(6):592–6. https://doi.org/10.1016/j.soard.2007.08.009.

    Article  Google Scholar 

  20. Albanopoulos K, Alevizos L, Natoudi M, Dardamanis D, Menenakos E, Stamou K, et al. C-reactive protein, white blood cells, and neutrophils as early predictors of postoperative complications in patients undergoing laparoscopic sleeve gastrectomy. Surg Endosc. 2013;27(3):864–71. https://doi.org/10.1007/s00464-012-2526-7.

    Article  Google Scholar 

  21. Herron D, Roohipour R. Complications of roux-en-Y gastric bypass and sleeve gastrectomy. Abdom Imaging. 2012;37(5):712–8. https://doi.org/10.1007/s00261-012-9866-6.

    Article  Google Scholar 

  22. Gagnière J, Slim K. Don’t let obese patients be discharged with tachycardia after sleeve gastrectomy. Obes Surg. 2012;22(9):1519–20. https://doi.org/10.1007/s11695-012-0712-2.

    Article  Google Scholar 

  23. Cottam D, Qureshi FG, Mattar SG, Sharma S, Holover S, Bonanomi G, 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. https://doi.org/10.1007/s00464-005-0134-5.

    Article  CAS  Google Scholar 

  24. De Aretxabala X, Leon J, Wiedmaier G, Turu I, Ovalle C, Maluenda F, et al. Gastric leak after sleeve gastrectomy: analysis of its management. Obes Surg. 2011;21(8):1232–7. https://doi.org/10.1007/s11695-011-0382-5.

    Article  Google Scholar 

  25. Car Peterko A, Kirac I, Gaurina A, Diklić D, Bekavac-Bešlin M. Diagnosis and management of acute and early complications of/ after bariatric surgery. Dig Dis. 2012;30(2):178–81. https://doi.org/10.1159/000336677.

    Article  CAS  Google Scholar 

  26. Silecchia G, Catalano C, Gentileschi P, Elmore U, Restuccia A, Gagner M, et al. Virtual gastroduodenoscopy: a new look at the bypassed stomach and duodenum after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg. 2002;12(1):39–48. https://doi.org/10.1381/096089202321144568.

    Article  Google Scholar 

  27. Triantafyllidis G, Lazoura O, Sioka E, Tzovaras G, Antoniou A, Vassiou K, et al. Anatomy and complications following laparoscopic sleeve gastrectomy: radiological evaluation and imaging pitfalls. Obes Surg. 2011;21(4):473–8. https://doi.org/10.1007/s11695-010-0236-6.

    Article  Google Scholar 

  28. Mittermair R, Sucher R, Perathoner A. Results and complications after laparoscopic sleeve gastrectomy. Surg Today. 2014;44(7):1307–12. https://doi.org/10.1007/s00595-013-0688-0.

    Article  Google Scholar 

  29. Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, Arvidsson D, Baker RS, Basso N, et al. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8(1):8–19. https://doi.org/10.1016/j.soard.2011.10.019.

    Article  Google Scholar 

  30. Márquez MF, Ayza MF, Lozano RB, Mdel M, Díez JM, Poujoulet RB. Gastric leak after laparoscopic sleeve gastrectomy. Obes Surg. 2010;20(9):1306–11. https://doi.org/10.1007/s11695-010-0219-7.

    Article  Google Scholar 

  31. Gagner M, Deitel M, Kalberer TL, Erickson AL, Crosby RD. The second international consensus summit for sleeve gastrectomy, March 19–21, 2009. Surg Obes Relat Dis. 2009;5(4):476–85. https://doi.org/10.1016/j.soard.2009.06.001.

    Article  Google Scholar 

  32. Basso N, Casella G, Rizzello M, Abbatini F, Soricelli E, Alessandri G, et al. Laparoscopic sleeve gastrectomy as first stage or definitive intent in 300 consecutive cases. Surg Endosc. 2011;25(2):444–9. https://doi.org/10.1007/s00464-010-1187-7.

    Article  CAS  Google Scholar 

  33. Gagner M, Deitel M, Erickson AL, Crosby RD. Survey on laparoscopic sleeve gastrectomy (LSG) at the fourth international consensus summit on sleeve gastrectomy. Obes Surg. 2013;23(12):2013–7. https://doi.org/10.1007/s11695-013-1040-x.

    Article  Google Scholar 

  34. Sakran N, Goitein D, Raziel A, Keidar A, Beglaibter N, Grinbaum R, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2013;27(1):240–5. https://doi.org/10.1007/s00464-012-2426-x.

    Article  Google Scholar 

  35. Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26(6):1509–15. https://doi.org/10.1007/s00464-011-2085-3.

    Article  Google Scholar 

  36. Chour M, Alami RS, Sleilaty F, Wakim R. The early use of Roux limb as surgical treatment for proximal postsleeve gastrectomy leaks. Surg Obes Relat Dis. 2014;10(1):106–10. https://doi.org/10.1016/j.soard.2013.08.017.

    Article  Google Scholar 

  37. Eubanks S, Edwards CA, Fearing NM, Ramaswamy A, de la Torre RA, Thaler KJ, et al. Use of endoscopic stents to treat anastomotic complications after bariatric surgery. J Am Coll Surg. 2008;206(5):935–9. https://doi.org/10.1016/j.jamcollsurg.2008.02.016.

    Article  Google Scholar 

  38. Eisendrath P, Cremer M, Himpens J, Cadière G-B, Le Moine O, Devière J. Endotherapy including temporary stenting of fistulas of the upper gastrointestinal tract after laparoscopic bariatric surgery. Endoscopy. 2007;39(7):625–30. https://doi.org/10.1055/s-2007-966533.

    Article  CAS  Google Scholar 

  39. Tan JT, Kariyawasam S, Wijeratne T, Chandraratna HS. Diagnosis and management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg. 2010;20(4):403–9. https://doi.org/10.1007/s11695-009-0020-7.

    Article  Google Scholar 

  40. Deitel M, Gagner M, Erickson AL, Crosby RD. Third international summit: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2011;7(6):749–59. https://doi.org/10.1016/j.soard.2011.07.017.

    Article  Google Scholar 

  41. Parikh M, Issa R, McCrillis A, Saunders JK, Ude-Welcome A, Gagner M. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg. 2013;257(2):231–7. https://doi.org/10.1097/SLA.0b013e31826cc714.

    Article  Google Scholar 

  42. Pequignot A, Fuks D, Verhaeghe P, Dhahri A, Brehant O, Bartoli E, et al. Is there a place for pigtail drains in the management of gastric leaks after laparoscopic sleeve gastrectomy? Obes Surg. 2012;22(5):712–20. https://doi.org/10.1007/s11695-012-0597-0.

    Article  CAS  Google Scholar 

  43. Serra C, Baltasar A, Andreo L, Pérez N, Bou R, Bengochea M, et al. Treatment of gastric leaks with coated self-expanding stents after sleeve gastrectomy. Obes Surg. 2007;17(7):866–72. https://doi.org/10.1007/s11695-007-9161-8.

    Article  Google Scholar 

  44. Papavramidis TS, Kotzampassi K, Kotidis E, Eleftheriadis EE, Papavramidis ST. Endoscopic fibrin sealing of gastrocutaneous fistulas after sleeve gastrectomy and biliopancreatic diversion with duodenal switch. J Gastroenterol Hepatol. 2008;23(12):1802–5. https://doi.org/10.1111/j.1440-1746.2008.05545.x.

    Article  Google Scholar 

  45. Conio M, Blanchi S, Repici A, Bastardini R, Marinari GM. Use of an over-the-scope clip for endoscopic sealing of a gastric fistula after sleeve gastrectomy. Endoscopy. 2010;42(Suppl 2):E71–2. https://doi.org/10.1055/s-0029-1215199.

    Article  Google Scholar 

  46. Bakhos C, Alkhoury F, Kyriakides T, Reinhold R, Nadzam G. Early postoperative hemorrhage after open and laparoscopic roux-en-y gastric bypass. Obes Surg. 2009;19(2):153–7. https://doi.org/10.1007/s11695-008-9580-1.

    Article  Google Scholar 

  47. Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000;232(4):515–29. https://doi.org/10.1097/00000658-200010000-00007.

    Article  CAS  Google Scholar 

  48. Hamad GG, Choban PS. Enoxaparin for thromboprophylaxis in morbidly obese patients undergoing bariatric surgery: findings of the prophylaxis against VTE outcomes in bariatric surgery patients receiving enoxaparin (PROBE) study. Obes Surg. 2005;15(10):1368–74. https://doi.org/10.1381/096089205774859245.

    Article  Google Scholar 

  49. Gugliotti DV. What is the optimal venous thromboembolism prophylaxis for patients undergoing bariatric surgery? IMPACT consults. Proceedings of the 2nd annual Cleveland clinic perioperative medicine summit. Cleve Clin J Med. 2006;73(Electronic Suppl 1):S17–8. https://doi.org/10.3949/ccjm.73.electronic_suppl_1.s17.

    Article  Google Scholar 

  50. Burgos AM, Csendes A, Braghetto I. Gastric stenosis after laparoscopic sleeve gastrectomy in morbidly obese patients. Obes Surg. 2013;23(9):1481–6. https://doi.org/10.1007/s11695-013-0963-6.

    Article  Google Scholar 

  51. Gagner M, Kemmeter P. Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review. Surg Endosc. 2020;34(1):396–407. https://doi.org/10.1007/s00464-019-06782-2.

    Article  Google Scholar 

  52. Warner DL, Sasse KC. Technical details of laparoscopic sleeve gastrectomy leading to lowered leak rate: discussion of 1070 consecutive cases. Minim Invasive Surg Nurs. 2017;2017:4367059. https://doi.org/10.1155/2017/4367059.

    Article  Google Scholar 

  53. Lynn W, Ilczyszyn A, Aguilo R, Agrawal S. Standardised sleeve gastrectomy without reinforcement. JSLS. 2018;22(3):e2018.00015. https://doi.org/10.4293/JSLS.2018.00015.

    Article  Google Scholar 

  54. Gagner M, Huang RY. Comparison between orogastric tube/bougie and a suction calibration system for effects on operative duration, staple-line corkscrewing, and esophageal perforation during laparoscopic sleeve gastrectomy. Surg Endosc. 2016;30(4):1648–55. https://doi.org/10.1007/s00464-015-4399-z.

    Article  Google Scholar 

  55. Zafar SN, Felton J, Miller K, Wise ES, Kligman M. Staple line treatment and bleeding after laparoscopic sleeve gastrectomy. JSLS. 2018;22(4):e2018.00056. https://doi.org/10.4293/JSLS.2018.00056.

    Article  Google Scholar 

  56. Pilone V, Tramontano S, Renzulli M, Romano M, Monda A, Albanese A, et al. Omentopexy with Glubran®2 for reducing complications after laparoscopic sleeve gastrectomy: results of a randomized controlled study. BMC Surg. 2019;19(Suppl 1):56. https://doi.org/10.1186/s12893-019-0507-7.

    Article  Google Scholar 

  57. Ortega CB, Guerron AD, Yoo JS. The use of fluorescence angiography during laparoscopic sleeve gastrectomy. JSLS. 2018;22(2):e2018.00005. https://doi.org/10.4293/JSLS.2018.00005.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Metabolic Surgery, Sana Klinikum Offenbach, Offenbach am Main, Germany

    Rudolf A. Weiner

  2. Department for Surgery of Obesity and Metabolic Disorders (Center of Excellence), Offenbach am Main, Germany

    Rudolf A. Weiner

  3. Department of General, Visceral and Minimally Invasive Surgery, Nordwest Hospital, Frankfurt am Main, Germany

    Sylvia Weiner

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  1. Rudolf A. Weiner
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Editors and Affiliations

  1. Homerton University Hospital, London, UK

    Sanjay Agrawal

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  1. Department of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), New Delhi, India

    Sandeep Aggarwal MBBS, MS, FACS

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Weiner, R.A., Weiner, S. (2023). Laparoscopic Sleeve Gastrectomy: Early Complications. In: Agrawal, S. (eds) Obesity, Bariatric and Metabolic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-60596-4_83

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  • DOI: https://doi.org/10.1007/978-3-030-60596-4_83

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