Laparoscopic Sleeve Gastrectomy Dr Ahmed Refaey Laparoscopic sleeve

Laparoscopic Sleeve Gastrectomy Dr. Ahmed Refaey

• Laparoscopic sleeve gastrectomy (LSG) is the technique comprises removal of the great curvature of the stomach , with a resection line parallel to the lesser curvature, so as to create a long tubular gastric remnant

COMPLICATIONS • • Early COMPLICATIONS( within 2 weeks) Hemorrhage Staple line leak Abscess Delayed COMPLICATIONS Stricture Gastroesophageal reflux disease

Complication Diagnosis Heamorrhage Physical findings, serial CBC Leak Physical findings, UGI series Abscess CT scan, ultrasound Stricture Endoscopy, UGI series GERD UGI series , endoscopy

• Leak • Gastric leak is one of the most serious complications of LSG • It occurs in up to 5% of patients following LSG.

Gastrografin swallow studies demonstrating staple line leaks (a), focal leak (b), and leaks with contrast dissemination in the abdominal cavity

CT images of staple line leak (a), left subphrenic gas and fluid collection (b), and drainage of the collection (c)

• postoperative air-fluid collection adjacent to GE junction consistent with staple line leak

An intraluminal stent for the treatment of a leak following laparoscopic sleeve gastrectomy.

• Abscess • It usually presents with symptoms of abdom inal pain, fever/chills or nausea and vomiting. • If there are clinical suspicions, one should obtain a computed tomography scan of the abdomen to rule out the presence of intraabdominal abscess.

• Perigastric abscess near the suture line and anterior to the left lobe of liver

• CHRONIC COMPLICATIONS • Stricture • Gastroesophageal reflux disease • An upper gastrointestinal study or endoscopy is usually diagnostic.

• Stricture • It could present either acutely after surgery due to tissue edema or more commonly in a delayed fashion. • Presenting symptoms include food intolerance, dysphagia or nausea and vomiting. •

• Gastroesophageal reflux disease

• Due to some technical difficulties during LSG, small part of stomach can be preserved either proximally or distally, giving radiological pattern which can be confused with leak.

• • • The radiological patterns include: tubular superior pouch Inferior pouch inferior–superior pouch

Superior pouches that resemble leaks. a) Small pouch with irregular upper contour. b) Small pouch with a narrow neck c) Small oblong pouch with an irregular outer contour

• In all patients, a UGI was routinely performed on POD 3 to exclude complications, primarily staple line leaks and strictures, and begin gradual fluid intake. • If a leak was detected, further imaging investigation by CT was performed to confirm the finding and exclude abscess formation.

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