Interesting Read Vsg

[Capt Derel 287]

Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients.

AuthorsAurora AR, et al. Show all Journal

Surg Endosc. 2011 Dec 17. [Epub ahead of print]

Affiliation

Department of Surgery, University Hospitals Case Medical Center, Lakeside 7, 11100 Euclid Avenue, Cleveland, Ohio, 44106, USA, aaurora@uchs.org.

Abstract

INTRODUCTION: Sleeve gastrectomy has become a popular stand-alone bariatric procedure with comparable weight loss and resolution of comorbidities to that of laparoscopic gastric bypass. The simplicity of the procedure and the decreased long-term risk profile make this surgery more appealing. Nonetheless, the ever present risk of a staple-line leak is still of great concern and needs further investigation.

METHODS: An electronic literature search of MEDLINE database plus manual reference checks of articles published on laparoscopic sleeve gastrectomy for morbid obesity and its complications was completed. Keywords used in the search were "sleeve gastrectomy" OR "gastric sleeve" AND "leak." We analyzed 29 publications, including 4,888 patients. We analyzed the frequency of leak after sleeve gastrectomy and its associated risks of causation.

RESULTS: The risk of leak after sleeve gastrectomy in all comers was 2.4%. This risk was 2.9% in the super-obese [body mass index (BMI) > 50 kg/m(2)] and 2.2% for BMI < 50 kg/m(2). Staple height and use of buttressing material did not affect leak rate. The use of a size 40-Fr or greater bougie was associated with a leak rate of 0.6% compared with those who used smaller sizes whose leak rate was 2.8%. Leaks were found at the proximal third of the stomach in 89% of cases. Most leaks were diagnosed after discharge. Endoscopic management is a viable option for leaks and was documented in 11% of cases as successful.

CONCLUSIONS: Sleeve gastrectomy has become an important surgical option for the treatment of the ever growing morbidly obese population. The risk of leak is low at 2.4%. Attention to detail specifically at the esophagogastric junction cannot be stressed enough. Careful patient selection (BMI < 50 kg/m(2)) and adopting the use of a 40-Fr or larger bougie may decrease the risk of leak. Vigilant follow-up during the first 30 days is critical to avoid catastrophe, because most leaks will happen after patient discharge.

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[Capt Derel 287]

Wow. Thats an eye opener

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[Oregondaisy 2,021]

That's why it's important to check out the surgeon you are choosing and find out his leak statistics.

[Capt Derel 287]

Management of gastrointestinal leaks after surgery for clinically severe obesity.

AuthorsSpyropoulos C, et al. Show all Journal

Surg Obes Relat Dis. 2011 Apr 27. [Epub ahead of print]

Affiliation

Department of Surgery, University Hospital of Patras, Rion, Greece.

Abstract

BACKGROUND: Gastrointestinal leaks after bariatric surgery are the primary cause of serious morbidity and mortality nationwide. Enteric leaks can differ in severity, presentation, and management, depending on the type of bariatric surgery performed. Our objective was to describe the clinical presentation and treatment outcomes in patients who developed postoperative leaks at a university hospital bariatric referral center.

METHODS: A retrospective observational study using descriptive statistics was conducted on data from 1499 bariatric operations performed at our institution from 1994 to 2010. The procedures included a variant of biliopancreatic diversion with long limb reconstruction (BPD-LL) in 820 patients (791 open and 29 laparoscopic), Roux-en-Y gastric bypass (RYGB) in 301 patients (105 open and 196 laparoscopic), and sleeve gastrectomy (SG) in 208 patients (5 open and 203 laparoscopic).

RESULTS: Of these patients, 30 (2%) developed a postoperative leak at a median of 18 days (range 2-32) postoperatively. The primary procedure was laparoscopic SG in 12 patients (5.8%), laparoscopic RYGB in 5 patients (1.6%), and BPD-LL (12 open and 1 laparoscopic) in 13 patients (1.6%). In all patients who underwent laparoscopic SG, the leak site was along the staple line. The gastrojejunal anastomosis was leaking in 4 (80%) and 12 (92.3%) patients in the RYGB and BPD-LL group, respectively. The enteroenteral anastomosis was leaking in 1 patient each in the RYGB and BPD-LL groups (20% and 7.7%, respectively). Three patients (10%; 2 from the BPD-LL group and 1 from the RYGB group) presented with generalized peritonitis and underwent emergency re-exploration; nonoperative treatment was successful in the remaining 27 patients (90%). Stent placement for persistent gastrocutaneous fistula was used in 9 patients (30%; 8 from the SG cohort and 1 from the BPD-LL group). The overall mortality rate was 3.3%.

CONCLUSION: In our experience, most leaks resulting from antiobesity surgery were successfully managed using nonoperative methods. Rapid management of gastrointestinal leaks using computed tomography-guided drainage and/or intraluminal stent placement could be the treatment of choice in selected patients.

Copyright © 2011 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

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[Capt Derel 287]

@ oregon. Theres no true way to find out a Drs leak rate.

But if you read this correctly. Leaks are more prone at the upper stomach where it connects to the esophagus and where they use a small bougie. Majority of the leaks show up after you get discharged. So after care is more important hence why I have scheduled 2 separate tests. One at 10days post op and the other 28 days post op. Its up to the patient to make sure everythings caught if something goes wrong when you goto Mexico regardless of which doc you choose over there.

I am educated more than you think lol but I have faith also

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[Oregondaisy 2,021]

I never thought you were not educated. Which surgeon are you going to in MX?

[andersonlj 32]

As there is probably no way to find out a doctors death rate either.

[Dooter 1,457]

So after care is more important hence why I have scheduled 2 separate tests. One at 10days post op and the other 28 days post op.

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I am going to Dallas to get this done, yet I live in New Mexico, so i do not have the advantage of popping over to my surgeon when concerned. That said, what tests did you have scheduled and what type of doc did you schedule it with? I like the idea...

[Pammie 8]

@Dooter, who is your surgeon?

[Dooter 1,457]

@Dooter, who is your surgeon?

Dr. David Kim in Colleyville. You?

[andersonlj 32]

One thing that I did after I got back from Mexico was scheduled an appt with my PCP and took her all of the records, labs, test that I had done in Mexico. I kept the orginal in case I need to head to an ER anytime. She did a complete blood workup on me and said that if I had any problems to call immediately.

one thing I like about my surgeon is that I had to pass 3 different leak tests before I was released from the hospital to the hotel in Mexico. I had them at different times after the surgery and the last one was done just before they pulled the drain. I was very happy that they checked for leaks so many times postop.

[Ms skinniness 3,003]

Owwwwwwww! I love that you did the research. This is very informative and gives a good guideline for individuals with bariatric surgeries. It' important that we are proactive in are care, because once we leave the hospital, the doc doesn't know what's going on unless we relay the info to them. My PCP told me that if there are no problems within the first 3 months, then it is presumed that the problem is not related to the surgery. I believe that if I have a leak in my stapleline, then it is totally related to the surgery. So, it is really important to be aware of what's going on in our bodies. If we have a pain, then that's our body telling us that somethings wrong. Listen to your body and if you have a shoulder pain, be proactive and call your doc. Best doc to call is the surgeon since our PCP's do not specialize in bariatric surgeries.

Also remember that the people in the study were a small number. We deal with it when it happens, but otherwise, don't worry about it, just be informed.

[andersonlj 32]

Since my surgeon is in Mexico I have to rely on my PCP as my bariatric surgeon here that did my first surgery has not discharged me from his practice since I went to Tijuana to have my second surgery. Does not really bother me as if I do have a problem and go to the ER they will still have to treat me as they can not refuse if I am an inpatient. Plus there are more than one bariatric surgeon in town.

[feedyoureye 3,087]

As there is probably no way to find out a doctors death rate either.

My Dr told me up front. I believe this must be public knowledge. Ask your Dr. If he/she will not tell you, then contact the ombudsman or the head of the facility with your question.

[andersonlj 32]

Do not think that will work for surgeons in other countries..............