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Complications of Sleeve Gastrectomy



Laparoscopic sleeve gastrectomy (LSG) is an increasingly used bariatric surgical procedure that consists of removing a large part of the stomach.

Significant advantages include the ease of performing the procedure (this used to be the “easy” first-step of a two-stage Roux-N-Y bypass in severely compromised patients), preservation of the pylorus, and maintenance of physiological food passage.

However, like all surgical procedures, it has its risks.

This prompted the recent report by Frezza and colleagues from the University of Alabama, Birmingham, Al, who examined the complication rates of LSG in their own case series and in 17 published articles from other centres (OBESITY SURGERY).

In their own case series of 53 patients who underwent LSG, no patients died but five (9.4%) developed complications which included two staple line leaks that required reoperations, one preceded by vomiting, the other by coughing as well as three staple line hemorrhages, one requiring hospitalization.

In the published articles, the median complication was 4.5%, with 3.6% of procedures requiring reoperation.

Thus, although the risk of death appears low, around 1 in 20 cases may require reoperation due to a perioperative complication.

Although this may sound a lot, it is important to remember that patients undergoing this operation are generally quite large (average BMI 51 in this case series) and quite sick (average of 8 co-morbidiites in this case series).

The authors calculate that it would actually require a study of more than 3,000 procedures to detect halving the odds of reoperation.

Because leaks and reoperation in this series were preceded by large increments in intraabdominal pressure, the authors propose that more attention to staple line reinforcements that increase burst pressure may be warranted.

Also, perioperative management to avoid vomiting and coughing may be helpful.

As bariatric surgery continues to evolve as by far the most effective treatment for severe obesity, everyone involved in the care of these patients must realize that surgical treatment of obesity will never be without risks.

AMS
Edmonton, Alberta

6 Comments

  1. We should also keep in mind that the sleeve is only one part of a duodewnal switch, so the complication rate for the switch has to be even higher

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  2. The LSG is in fact a stand alone procedure currently and Frezzas study was looking at Sleeve as a primary operation, not as part of the BPD-DS. The idea of staple line reinforcement is an important one, a recent study by Nguyen et al., looked at intraluminal burst pressures in stomachs with and without reinforcement and demonstrated a 20mmHg difference in reinforced stomachs. This may be a key issue in sleeves.

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  3. Dear Doctor:
    My wife had pancreatitis back in 2011. She is 28 now and the BMI is 32. Her triglyceride level was 6000 and glucose level was exceeding normal range. Even the most recent lap work done in 2012 shows tyiglyceride level of 1866, glucose 228. She decided to do the gastric bypass surgery in hopes of treating type 2 diabetes and hypertryglicermedia. However, as we learn more about the complications, the more hesitate we were. Then we learn about Laproscopic sleeve gastrectomy, it seems like a safer option. We learned that the successful rate is only 51% in treating type 2 diabetes and hypertryglicermedia compared to gastric bypass of 91% successful rate.
    (1) Do you suggest her do the sleeve gastrectomy and see if the type II diabetes and hypertyglicermedia would be cured? Or you think it’s better for her to do gastric bypass ?
    (2) If she undergo sleeve gastrorectomy and don’t see improvement in those 2 conditions, would her risk to do gastric bypass be significantly higher?
    Thanks!

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  4. Dear Dr,
    I had a sleeve on may 16, 3 weeks later, I was in again and a leak and infection was diagnosed. It was corrected with more lap surgery and anti biotics. Discharged after 20 days. I am now at 2.5 months after second procedure and I find eating the correct amount difficult. I feel ill after each meal with a feeling of bloating, it is making me fear having meals at all !
    A feeling of hunger has disappeared but been replaced with an uncomfortable feeling like a knot or something stuck. This is not satisfied by food as such, but when I then eat, I do not feel particularly well afterwards. The surgeon has referred me to follow up specialist nurses but not for another 2 months. A friend who has had a sleeve with less complications says this “knot” feeling disappears after 3 months.

    Terry

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  5. Dear Doctor Sharma,

    My brother recently underwent a gastric sleeve surgery. After 2 days, he had a staple line leak and the doctors had to stitch it up and add a drain pipe.
    During this time, he developed an infection (pneumonia) and got breathless. This was treated with antibiotics. The infection cleared but they his acid reflux persisted and the drain fluid did not subside. He was taken in for surgery again to insert two removable stents along the line of the stitching. Now he is suffering from Bile reflux followed by occasional vomiting. He has a burping and bloated feeling which does not seem to go away with meds such as Domperidon, ondanestron, gaviscon, remeron.

    What are your thoughts on introducing a cholesterol medicine such as Questran® and Colestid® assist the body in removing bile ? And also, do you think Hyperbaric Oxygen treatment can be given to heal the wounds inside the stomach so that the stents can be removed?

    please advise.

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    • Sorry to hear about the complications but these are questions for a surgeon – I’m an internist.

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