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      Complications of staple line and anastomoses following laparoscopic bariatric surgery

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          Abstract

          With over 600 million people being obese, and given the scientific demonstration of the advantages of surgical treatment, bariatric surgery is on the rise. The promising long-term results in terms of weight loss, and particularly in relation to comorbidities and the control/cure rate, mean that the number of procedures performed in all countries remains high. However, the risk of potentially complex or fatal complications, though small, is present and is related to the procedures per se. This review is a guide for bariatric and/or general surgeons, offering a complete overview of the pathogenesis of anastomosis and staple line following the most common laparoscopic bariatric procedures: sleeve gastrectomy, gastric bypass, and mini-gastric bypass. The review is divided according to the procedure and the complications (leak, bleeding and stenosis), and evaluates all the factors that can potentially improve or worsen the complication rate, representing a “unicum” in the present literature on bariatric surgery.

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          International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases.

          Raul J Rosenthal (2012)
          Laparoscopic sleeve gastrectomy (LSG) is an emerging surgical approach, but 1 that has seen a surge in popularity because of its perceived technical simplicity, feasibility, and good outcomes. An international expert panel was convened in Coral Gables, Florida on March 25 and 26, 2011, with the purpose of providing best practice guidelines through consensus regarding the performance of LSG. The panel comprised 24 centers and represented 11 countries, spanning all major regions of the world and all 6 populated continents, with a collective experience of >12,000 cases. It was thought prudent to hold an expert consensus meeting of some of the surgeons across the globe who have performed the largest volume of cases to discuss and provide consensus on the indications, contraindications, and procedural aspects of LSG. The panel undertook this consensus effort to help the surgical community improve the efficacy, lower the complication rates, and move toward adoption of standardized techniques and measures. The meeting took place at on-site meeting facilities, Biltmore Hotel, Coral Gables, Florida.
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            Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases.

            Aileen McCrillis, Michel Gagner, Manish Parikh … (2013)
            To conduct a systematic review to identify surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy (LSG). LSG is growing in popularity as a primary bariatric procedure. Technical aspects of LSG including bougie size remain controversial. Our systematic review yielded 112 studies encompassing 9991 LSG patients. A general estimating equation (GEE) model was used to calculate the odds ratio (OR) for leak based on bougie size, distance from the pylorus, and use of buttressing on the staple line. Baseline characteristics, including age and body mass index (BMI), were included. A linear repeated measures regression model compared excess weight loss (%EWL) between bougie sizes. A total of 198 leaks in 8922 patients (2.2%) were identified. The GEE model revealed that the risk of leak decreased with bougie ≥40 Fr (OR = 0.53, 95% CI = [0.37-0.77]; P = 0.0009). Buttressing did not impact leak. There was no difference in %EWL between bougie <40 Fr and bougie ≥40 Fr up to 36 months (mean: 70.1% EWL; P = 0.273). Distance from the pylorus did not affect leak or %EWL. Utilizing bougie ≥40 Fr may decrease leak without impacting %EWL up to 3 years. Distance from the pylorus does not impact leak or weight loss. Buttressing does not seem to impact leak; however, if surgeons desire to buttress, bioabsorbable material is the most common type used. Longer-term studies are needed to definitively determine the effect of bougie size on weight loss after LSG.
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              Continued excellent results with the mini-gastric bypass: six-year study in 2,410 patients.

              R. Walsh, Robert Rutledge (2005)
              There is a growing body of evidence showing that the Mini-Gastric Bypass (MGB) is a safe and effective alternative to other bariatric surgical operations. This study reports on the results of a consecutive cohort of patients undergoing the MGB. A prospective database was used to continuously assess the results in 2,410 MGB patients treated from September 1997 to February 2004. The average operative time was 37.5 minutes, and the median length of stay was 1 day. The 30-day mortality and complication rates were 0.08% and 5.9% respectively. The leak rate was 1.08%. Average weight loss at 1 year was 59 kg (80% of excess body weight). The most frequent long-term complications were dyspepsia and ulcers (5.6%) and iron deficiency anemia (4.9%.) Excessive weight loss with malnutrition occurred in 1.1%. Weight loss was well maintained over 5 years, with <5% patients regaining more than 10 kg. Overall, the MGB is very safe initially and in the long-term. It has reliable weight loss and complications similar to other forms of gastric bypass.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ann Gastroenterol
                Journal ID (iso-abbrev): Ann Gastroenterol
                Title: Annals of Gastroenterology
                Publisher: Hellenic Society of Gastroenterology (Greece )
                ISSN (Print): 1108-7471
                ISSN (Electronic): 1792-7463
                Publication date (Print): Jan-Feb 2018
                Publication date (Electronic): 12 October 2017
                Volume: 31
                Issue: 1
                Pages: 56-64
                Affiliations
                [1]Department of Medical-Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Centre of Excellence, University of Rome “La Sapienza”, Rome, Italy
                Author notes
                Correspondence to: Angelo Iossa MD, Department of Medico-Surgical Sciences and Biotechnologies Division of General Surgery and Bariatric Center of Excellence, “La Sapienza”, University of Rome, Italy, e-mail: angelo.iossa@ 123456uniroma1.it , angelo.iossa@ 123456gmail.com
                Article
                Publisher ID: AnnGastroenterol-31-56
                DOI: 10.20524/aog.2017.0201
                PMC ID: 5759613
                PubMed ID: 29333067
                SO-VID: 4816ed59-f29f-44ac-a9d2-2442974f446c
                Copyright © Copyright: © Hellenic Society of Gastroenterology
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 31 May 2017
                Date accepted : 08 September 2017
                Categories
                Subject: Invited Review

                Keywords: bariatric surgery,complications,laparoscopic,staple line,prevention,leaks,stenosis,bleeding
                Data availability:
                Keywords: bariatric surgery, complications, laparoscopic, staple line, prevention, leaks, stenosis, bleeding

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