SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY THE EXPERIENCE

SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY: THE EXPERIENCE OF A REFERRAL CENTER. Dr. W. JAMAL, 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 - 1 st 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 D 11 - OR: Well managed, Well tolerated - D 18 upper GI Hg, OGD - D 34 (Hemorragic Choc), Transfusion 12 PRBC - CT-Scan: Rupture of Pseudo. Anurism of SA - Transfered to HEGP - Embolisation - Dischared 1 m HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE

SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY Mrs. (3) - 43 y. o - Sleeve G 21 sept 2010 - D 2 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 - D 3 Respiratory Distress - Barium Meal: NO Leak - CT-Scan: Perisplenic Fluid Collection - Antibiotic + Transferred to HEGP - CT-Scan 2: 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 D 1, fever 40, WBC 20000 - CT-Scan D 2, 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 - Pseudo. Anurism - Gastro-Cutaneous Fistula - Oeso-Gastric Leaks - Calibration tube Stapling - Gastropleural Fistula - Abces - Twist N= Tx 1 Embolisation 2 Clips 5 3 Drainage, 1 Clip, 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