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
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
Sleeve Gastrectomy And Bariatric Surgery
Popularity
Indications
Efficacity
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
Sleeve Gastrectomy
- Restrictive Procedure
- Frequency
- Effective weight loss
- Resolution of co-morbidity
Effective
Difficult
<
<
- Part Of BPD-DS
- 1st Step in super-super obese (BMI > 60)
- Stand alone
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
- 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
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
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
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
Mme (1)
- Decrease in Drainage
- Resume Oral Intake
- Discharged Home with Abdominal Drainage
- Readdmition; Respiratory Distress and
Pneumopathy (Recurrence Oeso-Pleural
Fistula)
- Antibiotic + Gastric Stent
- Recurrence Oeso-Pleural Fistula
OR: Total Gastectomy
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
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
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
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
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
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
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
Mrs (5)
- 30 y.o
- Sleeve Gastrectomy
- Post-Op OK, BUT……
- Progressive Food Intake Intolerance
- 3 OGD Unremarkable
- Barium Meal ……..
What to do ??
TWIST
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
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
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
DIAGNOSTIQUE
- PseudoAnurism
- Gastro-Cutaneous Fistula
- Oeso-Gastric Leaks
- Calibration tube Stapling
- Gastropleural Fistula
- Abces
- Twist
N=
Tx
1
Embolisation
2
Clips
5 3Drainage,1Clip, 1TG
1
TG
1
TG
2
Drainage
1
Stent
Mean Length of Hospital Stay = 60 Jours ( 13, 135)
Mean Number of Admission = 1.9 Hospi (1, 4)
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
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.
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE