Year 2020 Vol. 28 No 5

CASE REPORTS

L.P. KOTELNIKOVA 1, 2, A.N. FEDACHUK 2, A.V. SHVAREV 2

EXPERIENCE IN THE TREATMENT OF LATE MECHANICAL SUTURE FAILURE AFTER LONGITUDINAL LAPAROSCOPIC SLEEVE GASTRECTOMY USING MINIMALLY INVASIVE TECHNIQUES

E.A.Vagner Perm State Medical University 1,
Perm Regional Clinical Hospitall 2, Perm,
The Russian Federation

Over the last decade laparoscopic sleeve gastrectomy has taken a leading position among bariatric operations. The failure of the mechanical suture of the gastric stump is considered to be the most severe complication in the postoperative period. The purpose of this report is to demonstrate a case of successful treatment of the late leakage of the gastric sleeve staple line with interventional methods. A 56-year-old patient with a body mass index of 50 underwent laparoscopic sleeve gastrectomy using a 36 Fr calibration probe. Check of the mechanical staple line for leak-tightness was carried out by the introduction of 150 ml of liquid colored methylene blue. On the 12th day after the operation computed tomography revealed suture incompetence. X-ray stomach examination was conducted twice, it was impossible to detect swelling of the contrast agent. To close the site of leakage, a fully covered self-expanding stent was installed endoscopically, and the zone of abscess was drained by relaparoscopy. When the stent removed below the cardiac pulp, it was reinstalled. After 4 weeks the fistula closed, and no swelling was detected on CT. The stent was removed and the patient was discharged from hospital in satisfactory condition.

Keywords: laparoscopic sleeve gastrectomy, leakage, self-expanding stent
p. 591-596 of the original issue
References
  1. Obesity / WHO [Internet]. Accessed April 2013. Available from: http://www.euro.who.int/en/health-topics/noncommunicable-diseases/obesity/obesity
  2. Dedov II, Melnichenko GA, Shestakova MV, Troshina EA, Mazurina NV, Shestakova EA, Yashkov YuI, Neimark AE, Birykova EV, Bondarenko IZ, Bordan NS, Dzgoeva FH, Ershova EV, Komshilova KA, Mkrtumyan AM, Petunina NA, Romantsova TI, Starostina EG, Strongin LG, Suplotova LA, Fadeev VV. Russian national clinical recommendations for morbid obesity treatment in adults. 3rd revision Morbid obesity treatment in adults. Ozhirenie i Metabolizm. 2018;15(1):53-70. doi: 10.14341/OMET2018153-70 (In Russ.)
  3. Yashkov YuI, Sedletskiy YuI, Vasilevskiy DI, Krichmar AM. Revision procedures in bariatric surgery. Pediatr. 2019;10(3): 81-91. https://doi.org:10.17816/PED10381-91 (In Russ.)
  4. Welbourn R, Hollyman M, Kinsman R, Dixon J, Liem R, Ottosson J, Ramos A, Väge V, Al-Sabah S, Brown W, Cohen R, Walton P, Himpens J. Bariatric Surgery Worldwide: Baseline Demographic Description and One-Year Outcomes from the Fourth IFSO Global Registry Report 2018. Obes Surg. 2019 Mar;29(3):782-95. doi: 10.1007/s11695-018-3593-1
  5. Zvirkun VV, Mosin SV, Askerkhanov RG, Feidorov IYU, Petrova AL, Izrailov RG, Kulezneva YUV, Khatkov IE. The case of a surgical treatment of patient with chronic leak after sleeve gastrectomy with two-step double-tract reconstruction. Hirurgija Zhurn im NI Pirogova. 2018;(6):115-19. https://doi.org:10.17116/hirurgia20186115-119 (In Russ.)
  6. Dakwar A, Assalia A, Khamaysi I, Kluger Y, Mahajna A. Late complication of laparoscopic sleeve gastrectomy. Case Rep Gastrointest Med. 2013;2013:136153. doi: 10.1155/2013/136153
  7. Jammah AA. Endocrine and metabolic complications after bariatric surgery. Saudi J Gastroenterol. 2015 Sep-Oct;21(5):269-77. doi: 10.4103/1319-3767.164183
  8. Praveenraj P, Gomes RM, Kumar S, Senthilnathan P, Parthasarathi R, Rajapandian S, Palanivelu C. Management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity: A tertiary care experience and design of a management algorithm. J Minim Access Surg. 2016 Oct-Dec;12(4):342-49. doi: 10.4103/0972-9941.181285
  9. Glinnik AA, Stebunov SS, Bogushevich OS, Rummo OO, Avlas SD, Minov AF. Nesostojatelnost linii mehanicheskogo shva posle rukavnoj rezekcii zheludka. Evrazijskij Sojuz Uchenyh. 2019;(4 ch 4):6162-69. doi: 10.31618/ESU. 2413-9335.2019.4.61.29 (In Russ.)
  10. Yashkov YI, Lutsevich , Bordan NS, Ivleva OV. Efficiency of laparoscopic sleeve gastrectomy in patients with obesity. Ozhirenie i Metabolizm. 2015;12(1):20-28. https://cyberleninka.ru/article/n/effektivnost-laparoskopicheskoy-prodolnoy-rezektsii-zheludka-u-bolnyh-ozhireniem (In Russ.)
  11. Todurov IM, Pleguca AI, Perehrestenko AV, Kalashnikov AA, Kosjuhno SV. Sleeve gastrectomy in patients with obesity. Morfologija. 2017;11(4):53-58. https://www.elibrary.ru/item.asp?id=35344772 (In Russ.)
  12. Schwarz J, Strobl FF, Paprottka PM, DAnastasi M, Spelsberg FW, Rentsch M, Reiser M, Trumm CG. CT fluoroscopy-guided drain placement to treat infected gastric leakage after sleeve gastrectomy: technical and clinical outcome of 31 procedures. Rofo. 2020 Feb;192(2):163-70. doi: 10.1055/a-0977-3496
  13. El-Sayes IA, Frenken M, Weiner RA. Management of leakage and stenosis after sleeve gastrectomy. Surgery. 2017 Sep;162(3):652-661. doi: 10.1016/j.surg.2017.04.015
Address for correspondence:
614000, Russian Federation,
Perm, Kuybyshev str., 43,
E.A. Vagner Perm State Medical University,
the Surgery Department with the Course
of the Cardiovascular Surgery
and Invasive Cardiology,
tel.: +7902 83 569 65,
e-mail: splaksin@mail.ru,
Kotelnikova Ludmila P.
Information about the authors:
Kotelnikova Liudmila P., MD, Professor, Head of the Surgery Department with the Course of the Cardiovascular Surgery and Invasive Cardiology, E.A.Vagner Perm State Medical University, Perm, Russian Federation.
https://orcid.org/0000-0002-8602-1405
Fedachuk Alexey N., PhD, Surgeon of the 1st Surgical Unit, Perm Regional Clinical Hospital, Perm, Russian Federation.
https://orcid.org/000-0001-5756-8981
Sharev Andrey V., Endoscopist, Head of the Endoscopy Unit, Perm Regional Clinical Hospital, Perm, Russian Federation
https://orcid.org/0000-0002-2853-7040
Contacts | ©Vitebsk State Medical University, 2007-2023