Outcomes of laparoscopic proximal gastrectomy with esophagojejunal reconstruction for chronic staple line disruption after laparoscopic sleeve gastrectomy.
BACKGROUND
Sleeve gastrectomy is now a frequently performed bariatric procedure for severely obese patients and may have the lowest frequency of short-term or long-term complications. The aim of this study is to describe our experience in managing chronic proximal leaks with a proximal gastrectomy and Roux-en-Y esophagojejunostomy (PGEJ).


METHODS
A retrospective review was performed of all patients having proximal chronic staple-line disruptions (CSLD) after undergoing laparoscopic sleeve gastrectomy.


RESULTS
Fifteen patients had proximal CSLD and were treated with PGEJ. There was 1 (6.6%) releak in this group, which resolved with nonoperative treatment. Other postoperative morbidities in this series included partial small bowel obstruction (n = 1) and subhepatic bile collection (n = 1), both of which resolved without operative intervention.


CONCLUSIONS
PGEJ appears to be a safe and effective procedure for chronic staple-line disruptions after sleeve gastrectomy.
The Bariatric and Metabolic Institute, Section of Minimally Invasive Surgery, Department of General & Vascular Surgery, Cleveland Clinic Florida, Weston, Florida.
Charles E
CE
Thompson
The Bariatric and Metabolic Institute, Section of Minimally Invasive Surgery, Department of General & Vascular Surgery, Cleveland Clinic Florida, Weston, Florida.
Hira
H
Ahmad
The Bariatric and Metabolic Institute, Section of Minimally Invasive Surgery, Department of General & Vascular Surgery, Cleveland Clinic Florida, Weston, Florida.
Emanuele
E
Lo Menzo
The Bariatric and Metabolic Institute, Section of Minimally Invasive Surgery, Department of General & Vascular Surgery, Cleveland Clinic Florida, Weston, Florida.
Samuel
S
Szomstein
The Bariatric and Metabolic Institute, Section of Minimally Invasive Surgery, Department of General & Vascular Surgery, Cleveland Clinic Florida, Weston, Florida. Electronic address: rosentr@ccf.org.
Raul J
RJ
Rosenthal
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak / Q000601:surgery; D002908:Chronic Disease; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D015391:Gastroplasty / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013536:Suture Techniques / Q000009:adverse effects*; D013537:Sutures; D013997:Time Factors; D055815:Young Adult
Laparoscopic sleeve gastrectomy; Leak; Proximal gastrectomy