title: Sleeve gastrectomy severe complications: is it always a reasonable surgical option?
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy (LSG) is widely adopted but exposes serious complications.
  
  
  METHODS
  A retrospective database analysis was done to study LSG staple line complications in a tertiary referral university center with surgical ICU experienced in treatment of morbid obesity and complications. Twenty-two consecutive patients were referred between January 2004 and February 2012 with postoperative gastric leak or stenosis after LSG. Interventions consisted in the control of intra-abdominal and general sepsis; restoration of staple line continuity or revision of LSG; nutritional support; treatment of associated complications. Main outcome measures concerned success rates of therapeutic strategies, morbidity and mortality rates, LOS, and time to cure.
  
  
  RESULTS
  Thirteen patients (59 %) were referred after failure of reoperation (seven fistula repairs were attempted). Three patients received emergency surgery in our center with transorificial intubation and jejunostomy formation. An endoscopic stent was tried in nine patients but failed in 84.6 % of cases within 20 days (1-161). Seven patients (32 %) necessitated total gastrectomy within 217 days (0-1,915 days) for conservative treatment failure. Procedures under general anesthesia were required in 41 % of cases, organ failure was found in 55 % of cases, and central venous device infection in 40 %. Mortality rate was 4.5 % (n = 1). Patients with unfavorable evolution of LSG complications (death or additional gastrectomy) had more previous bariatric procedure (82 % vs. 18 %, p = 0.003). Median time to cure was 310 days (9-546 days).
  
  
  CONCLUSIONS
  LSG exposes severe complications occurring in patients with benign condition. Endoscopic stents entail high failure rate. Total gastrectomy is required in one third of the cases.
authors: Assistance Publique-Hôpitaux de Paris, University Paris 5, Paris, France.
authors: David
authors: D
authors: Moszkowicz
authors: Roberto
authors: R
authors: Arienzo
authors: Idir
authors: I
authors: Khettab
authors: Gabriel
authors: G
authors: Rahmi
authors: Franck
authors: F
authors: Zinzindohoué
authors: Anne
authors: A
authors: Berger
authors: Jean-Marc
authors: JM
authors: Chevallier
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D015992:Body Mass Index; D003251:Constriction, Pathologic / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D005260:Female; D005602:France / Q000453:epidemiology; D005747:Gastric Fistula / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D015391:Gastroplasty / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D018579:Patient Selection; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D017211:Treatment Failure; D015431:Weight Loss
references: Obes Surg. 2010 Apr;20(4):519-22
references: 19575273
references: Surg Endosc. 2012 Jun;26(6):1509-15
references: 22179470
references: Am Surg. 2005 Jan;71(1):6-10; discussion 10-2
references: 15757050
references: Obes Facts. 2011;4 Suppl 1:42-6
references: 22027290
references: Arch Surg. 2012 Aug;147(8):694-700
references: 22508671
references: Obes Surg. 2009 Dec;19(12):1612-6
references: 19711138
references: N Engl J Med. 2007 Aug 23;357(8):753-61
references: 17715409
references: J Visc Surg. 2012 Apr;149(2):e143-52
references: 22386891
references: N Engl J Med. 2007 Aug 23;357(8):741-52
references: 17715408
references: Ann Surg. 2010 Aug;252(2):319-24
references: 20622654
references: Obes Surg. 2011 Feb;21(2):157-60
references: 21113685
references: Obes Surg. 2008 May;18(5):560-5
references: 18317859
references: Obes Surg. 2011 Aug;21(8):1209-19
references: 20676940
references: Obes Surg. 2010 Sep;20(9):1289-92
references: 20443150
references: Obes Surg. 2000 Dec;10(6):514-23; discussion 524
references: 11175958
references: Surg Obes Relat Dis. 2011 Nov-Dec;7(6):749-59
references: 21945699
references: Obes Surg. 2009 May;19(5):632-40
references: 19184256
references: Gastrointest Endosc. 2011 Dec;74(6):1416-9
references: 22136786
references: Br J Surg. 2001 Sep;88(9):1157-68
references: 11531861
references: Ann Surg. 2007 Dec;246(6):1034-9
references: 18043107
references: Surgery. 2009 Jan;145(1):106-13
references: 19081482
references: Surg Endosc. 2007 Nov;21(11):1927-30
references: 17768660
references: Surg Endosc. 2011 Aug;25(8):2498-504
references: 21359900
references: Obes Surg. 2008 Sep;18(9):1130-3
references: 18566866
references: Surg Obes Relat Dis. 2008 Nov-Dec;4(6):759-63
references: 18951853
references: Obes Surg. 2011 Aug;21(8):1232-7
references: 21416198
references: J Gastrointest Surg. 2010 Sep;14(9):1343-8
references: 20567930
references: Obes Surg. 2010 Apr;20(4):403-9
references: 19936855
references: Ann Surg. 2004 Aug;240(2):205-13
references: 15273542
references: J Gastrointest Surg. 2012 Aug;16(8):1585-9
references: 22396090
references: Gastrointest Endosc. 2011 Feb;73(2):238-44
references: 21295637
references: Obes Surg. 2011 Jul;21(7):832-5
references: 20924713
references: Obes Surg. 2008 May;18(5):487-96
references: 18357494
references: Ann Surg. 2005 Jul;242(1):20-8
references: 15973097
references: Surg Obes Relat Dis. 2012 Jan-Feb;8(1):8-19
references: 22248433