SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY: THE EXPERIENCE OF A REFERRAL CENTER.

SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE

GASTRECTOMY: THE EXPERIENCE OF A REFERRAL CENTER.

Dr. W. JAMAL, DES, DESC

Department of General Surgery

King Abdulaziz University Hospital - Jeddah

SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE

GASTRECTOMY: THE EXPERIENCE OF A REFERRAL CENTER.

Dr. W. JAMAL,

Prof. JM. CHEVALLIER

Department of General & Digestive Surgery,

HOPITAL EUROPEEN GEORGES POMPIDOU, APHP Paris - FRANCE

SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY

HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE

Sleeve Gastrectomy And Bariatric Surgery

Popularity

Indications

Efficacity





Sleeve Gastrectomy- Restrictive Procedure- Frequency- Effective weight loss- Resolution of co-morbidity

- Part Of BPD-DS- 1st Step in super-super obese (BMI > 60)- Stand alone

Effective

<

Difficult

<

- 13 Patients Transfered to HEGP after Sleeve

- M = 1, F = 12

- Age 45.5 ( 35 – 60 ans)

- 3/13 SG (BPD-DS)

- 10/13 Sleeve (stand-alone)

- 5 after failed Band



Mrs. (1)

- 54 y.o- Failed Band- Sleeve Gastrectomy + BPD-DS- Gastric leak- Transferred to HEGP- Imaging: Lt. Oeso – Pleural Fistula + Abces- OR: Lavage + Drainage + J Feeding- Thoracic Drainage



- Decrease in Drainage- Resume Oral Intake- Discharged Home with Abdominal Drainage

- Readdmition; Respiratory Distress and Pneumopathy (Recurrence Oeso-Pleural Fistula)- Antibiotic + Gastric Stent

Mme (1)

- Recurrence Oeso-Pleural Fistula

OR: Total GastectomyHOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE


Mrs. (2)

- 57 y.o

- Gastric Band 1999, Removal of Band 2002

- Sleeve G + BPD-DS on 16/11/2005

- Gastric Leak at D11

- OR: Well managed, Well tolerated

- D18 upper GI Hg, OGD

- D34 (Hemorragic Choc), Transfusion 12 PRBC

- CT-Scan: Rupture of PseudoAnurism of SA

- Transfered to HEGP

- Embolisation

- Dischared 1m HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE


Mrs. (3)

- 43 y.o

- Sleeve G 21 sept 2010

- D2 Gastric Leak + Lt. sub-phrenic Abces

- OR: Drainage + J Feeding +Antibiotic

- Transferred to HEGP

- Sepsis (Pneumopathy)

- Failure Gastric Stent X 2

- Clip OVESCO 15/12/2010



Mrs (4)

- 60 y.o

- Sleeve G 22/7/2010

- D3 Respiratory Distress

- Barium Meal: NO Leak

- CT-Scan: Perisplenic Fluid Collection

- Antibiotic + Transferred to HEGP

- CT-Scan2: Gastric Leak + Lt. Sub-Phrenic Collection + Lt. Pleural

Effusion

-OR: Intubation of Leakage Site by T-tube Drain + Drainage + J Feeding

- Resume Oral Intake + Removal Of T-tube on October 2010



Mrs (5)

- 30 y.o- Sleeve Gastrectomy- Post-Op OK, BUT……- Progressive Food Intake Intolerance - 3 OGD Unremarkable- Barium Meal ……..

TWIST

What to do ??



Mrs (6)

- 35 y.o - Failure Gastric Band Placement in 2008- 21/10/2010 Failure Band ---} Sleeve- Stabling Calibration tube + important Hg- Conversion to Laparotomie, Anastomose Oeso-J- Methylen Blue Test Positive- ICU, Extubation at D1, fever 40, WBC 20000- CT-Scan D2, 2 Leaks- Transferred to HEGP- OR: Intubation of Leakage site (Spirale)- Resume Oral Intake on March 2011



DIAGNOSTIQUE N= Tx

- PseudoAnurism 1 Embolisation- Gastro-Cutaneous Fistula 2 Clips- Oeso-Gastric Leaks 5 3Drainage,1Clip, 1TG- Calibration tube Stapling 1 TG- Gastropleural Fistula 1 TG- Abces 2 Drainage- Twist 1 Stent

Mean Length of Hospital Stay = 60 Jours ( 13, 135)

Mean Number of Admission = 1.9 Hospi (1, 4)



CONCLUSION:


Sleeve Gastrectomy is an effective weight loss procedure, despite its complications which are rare, it could be serious and considerably extend the legnth of hospital stay, with important fonctional and psychological consequences on patients.


SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY: THE EXPERIENCE OF A REFERRAL CENTER.

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