Laparoscopic Roux-en-Y fistulo-jejunostomy as a salvage procedure in patients with chronic gastric leak after sleeve gastrectomy.
EAES Academy. Lainas P. 07/05/22; 362959; P002
Dr. Panagiotis Lainas
Contributions
Contributions
Abstract
Aims:
Laparoscopic sleeve gastrectomy (LSG) is the most frequent bariatric surgical procedure performed worldwide. Its most common postoperative complication is staple line leak (less than 3% in bariatric surgery specialized centers). Even though the rate of gastric leak following LSG has been remarkably reduced during the last years, the management of chronic leaks remains challenging. We present the results of a series of patients treated with laparoscopic Roux-en-Y fistulo-jejunostomy (LRYFJ) for a chronic gastric leak (> 12 weeks) post-LSG. Methods: Data were prospectively gathered in an electronic database and retrospectively analyzed for all consecutive patients undergoing LRYFJ for chronic gastric leak in two specialized bariatric centers in France. Parameters of interest were patient characteristics, intraoperative data, post-operative complications and outcomes, length of hospital stay and follow-up. Hemodynamically unstable patients and patients presenting signs of severe sepsis were excluded from this study. Laparoscopy was attempted for all patients. Surgical technique was standardized in both centers. Results: Between March 2017 and December 2019, 11 patients had a LRYFJ for chronic gastric leak (9 women, 2 men). Median age was 49.2 years, median weight 102 kg and median body mass index (BMI) 35.6 kg/m2. All procedures were performed successfully by laparoscopy, with a median operating time of 198 minutes. Mortality was null. One conversion to laparotomy was necessary (9.1%). Three patients (27.2%) presented a post-operative complication: one patient suffered pneumonia treated successfully conservatively by antibiotics, and two patients a gastro-jejunal anastomosis leak detected on postoperative days 3 and 22, respectively. Both cases were treated by antibiotics and endoscopic internal drainage. Median duration of hospitalization was 17 days. Conclusions: LRYFJ seems to be a good surgical option for the treatment of chronic gastric leaks after LSG. However, it is a challenging procedure and should be performed in experienced bariatric centers by expert bariatric surgeons. Careful patient selection is essential since this approach should only be considered in patients with adequate nutritional status and after failure of a well conducted endoscopic management.
Laparoscopic sleeve gastrectomy (LSG) is the most frequent bariatric surgical procedure performed worldwide. Its most common postoperative complication is staple line leak (less than 3% in bariatric surgery specialized centers). Even though the rate of gastric leak following LSG has been remarkably reduced during the last years, the management of chronic leaks remains challenging. We present the results of a series of patients treated with laparoscopic Roux-en-Y fistulo-jejunostomy (LRYFJ) for a chronic gastric leak (> 12 weeks) post-LSG. Methods: Data were prospectively gathered in an electronic database and retrospectively analyzed for all consecutive patients undergoing LRYFJ for chronic gastric leak in two specialized bariatric centers in France. Parameters of interest were patient characteristics, intraoperative data, post-operative complications and outcomes, length of hospital stay and follow-up. Hemodynamically unstable patients and patients presenting signs of severe sepsis were excluded from this study. Laparoscopy was attempted for all patients. Surgical technique was standardized in both centers. Results: Between March 2017 and December 2019, 11 patients had a LRYFJ for chronic gastric leak (9 women, 2 men). Median age was 49.2 years, median weight 102 kg and median body mass index (BMI) 35.6 kg/m2. All procedures were performed successfully by laparoscopy, with a median operating time of 198 minutes. Mortality was null. One conversion to laparotomy was necessary (9.1%). Three patients (27.2%) presented a post-operative complication: one patient suffered pneumonia treated successfully conservatively by antibiotics, and two patients a gastro-jejunal anastomosis leak detected on postoperative days 3 and 22, respectively. Both cases were treated by antibiotics and endoscopic internal drainage. Median duration of hospitalization was 17 days. Conclusions: LRYFJ seems to be a good surgical option for the treatment of chronic gastric leaks after LSG. However, it is a challenging procedure and should be performed in experienced bariatric centers by expert bariatric surgeons. Careful patient selection is essential since this approach should only be considered in patients with adequate nutritional status and after failure of a well conducted endoscopic management.
Aims:
Laparoscopic sleeve gastrectomy (LSG) is the most frequent bariatric surgical procedure performed worldwide. Its most common postoperative complication is staple line leak (less than 3% in bariatric surgery specialized centers). Even though the rate of gastric leak following LSG has been remarkably reduced during the last years, the management of chronic leaks remains challenging. We present the results of a series of patients treated with laparoscopic Roux-en-Y fistulo-jejunostomy (LRYFJ) for a chronic gastric leak (> 12 weeks) post-LSG. Methods: Data were prospectively gathered in an electronic database and retrospectively analyzed for all consecutive patients undergoing LRYFJ for chronic gastric leak in two specialized bariatric centers in France. Parameters of interest were patient characteristics, intraoperative data, post-operative complications and outcomes, length of hospital stay and follow-up. Hemodynamically unstable patients and patients presenting signs of severe sepsis were excluded from this study. Laparoscopy was attempted for all patients. Surgical technique was standardized in both centers. Results: Between March 2017 and December 2019, 11 patients had a LRYFJ for chronic gastric leak (9 women, 2 men). Median age was 49.2 years, median weight 102 kg and median body mass index (BMI) 35.6 kg/m2. All procedures were performed successfully by laparoscopy, with a median operating time of 198 minutes. Mortality was null. One conversion to laparotomy was necessary (9.1%). Three patients (27.2%) presented a post-operative complication: one patient suffered pneumonia treated successfully conservatively by antibiotics, and two patients a gastro-jejunal anastomosis leak detected on postoperative days 3 and 22, respectively. Both cases were treated by antibiotics and endoscopic internal drainage. Median duration of hospitalization was 17 days. Conclusions: LRYFJ seems to be a good surgical option for the treatment of chronic gastric leaks after LSG. However, it is a challenging procedure and should be performed in experienced bariatric centers by expert bariatric surgeons. Careful patient selection is essential since this approach should only be considered in patients with adequate nutritional status and after failure of a well conducted endoscopic management.
Laparoscopic sleeve gastrectomy (LSG) is the most frequent bariatric surgical procedure performed worldwide. Its most common postoperative complication is staple line leak (less than 3% in bariatric surgery specialized centers). Even though the rate of gastric leak following LSG has been remarkably reduced during the last years, the management of chronic leaks remains challenging. We present the results of a series of patients treated with laparoscopic Roux-en-Y fistulo-jejunostomy (LRYFJ) for a chronic gastric leak (> 12 weeks) post-LSG. Methods: Data were prospectively gathered in an electronic database and retrospectively analyzed for all consecutive patients undergoing LRYFJ for chronic gastric leak in two specialized bariatric centers in France. Parameters of interest were patient characteristics, intraoperative data, post-operative complications and outcomes, length of hospital stay and follow-up. Hemodynamically unstable patients and patients presenting signs of severe sepsis were excluded from this study. Laparoscopy was attempted for all patients. Surgical technique was standardized in both centers. Results: Between March 2017 and December 2019, 11 patients had a LRYFJ for chronic gastric leak (9 women, 2 men). Median age was 49.2 years, median weight 102 kg and median body mass index (BMI) 35.6 kg/m2. All procedures were performed successfully by laparoscopy, with a median operating time of 198 minutes. Mortality was null. One conversion to laparotomy was necessary (9.1%). Three patients (27.2%) presented a post-operative complication: one patient suffered pneumonia treated successfully conservatively by antibiotics, and two patients a gastro-jejunal anastomosis leak detected on postoperative days 3 and 22, respectively. Both cases were treated by antibiotics and endoscopic internal drainage. Median duration of hospitalization was 17 days. Conclusions: LRYFJ seems to be a good surgical option for the treatment of chronic gastric leaks after LSG. However, it is a challenging procedure and should be performed in experienced bariatric centers by expert bariatric surgeons. Careful patient selection is essential since this approach should only be considered in patients with adequate nutritional status and after failure of a well conducted endoscopic management.
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