Roux-en-Y Gastric Bypass for the Treatment of Leak Following Sleeve Gastrectomy
Purpose Laparoscopic sleeve gastrectomy (LSG) is estimated to be its most severe complication. An aggressive management with surgical reconstructive procedures can be proposed in patients in whom all the conservative endoscopic techniques fail. The purpose of the present study was to report our expe...
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| Veröffentlicht in: | Obesity surgery 2021, Vol.31 (1), p.79-83 |
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| creator | Degrandi, Olivier Nedelcu, Anamaria Nedelcu, Marius Simon, Agathe Collet, Denis Gronnier, Caroline |
| description | Purpose
Laparoscopic sleeve gastrectomy (LSG) is estimated to be its most severe complication. An aggressive management with surgical reconstructive procedures can be proposed in patients in whom all the conservative endoscopic techniques fail. The purpose of the present study was to report our experience with Roux-en-Y gastric bypass (RYGBP) as treatment for the chronic leak after LSG.
Methods
Between January 2013 and July 2019, 17 consecutive patients underwent RYGBP for the treatment of chronic leak after LSG. The initial intervention, the endoscopic approach and the definitive surgical repair were carefully reviewed.
Results
Seventeen patients (13 women) with a median age of 39 years (24–67) with a median body mass index (BMI) of 40 kg/m
2
(30–52) underwent RYGBP for persistent fistula. Sixteen patients had their early LSG performed in another hospital. Eleven patients had an initial endoscopic treatment by pigtail drains following laparoscopic drainage and 6 other patients had the endoscopic stent as the first-choice line treatment. The overall average fistula diagnosis was done at 7.7 months (2–49 months) for 12 patients. For the rest of five patients, the procedure was performed almost in the acute setting ( |
| doi_str_mv | 10.1007/s11695-020-04646-6 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2442600983</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2442600983</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-fa183988548258e9c03a192e82e58fc89de02f15591d9391b12fe49b0a29c963</originalsourceid><addsrcrecordid>eNp9kMFO3DAQhq2qqLvQvkAPlaVeuBjG48SxjxTBgrTSSrAXTpY3O6FLk3ixE2DfntBsW4lDT6PRfPPP6GPsq4QTCVCcJim1zQUgCMh0poX-wKayADO0aD6yKVgNwlhUE3aY0gMASo34iU0UWgSd2ylb3IT-RVAr7vjMpy5uSv5jt_Up8SpE3v0kvozku4bajoeKz8n_4pehrsPzpr3ntzXRE42bVHah2X1mB5WvE33Z1yO2vLxYnl-J-WJ2fX42F6Uq8k5UXhpljckzg7khW4Ly0iIZpNxUpbFrAqxknlu5tsrKlcSKMrsCj7a0Wh2x4zF2G8NjT6lzzSaVVNe-pdAnh1mGGsAaNaDf36EPoY_t8NxAFYVBlFgMFI5UGUNKkSq3jZvGx52T4N5su9G2G2y737bd2xff9tH9qqH135U_egdAjUAaRu09xX-3_xP7CgyKiCU</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2477822127</pqid></control><display><type>article</type><title>Roux-en-Y Gastric Bypass for the Treatment of Leak Following Sleeve Gastrectomy</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Degrandi, Olivier ; Nedelcu, Anamaria ; Nedelcu, Marius ; Simon, Agathe ; Collet, Denis ; Gronnier, Caroline</creator><creatorcontrib>Degrandi, Olivier ; Nedelcu, Anamaria ; Nedelcu, Marius ; Simon, Agathe ; Collet, Denis ; Gronnier, Caroline</creatorcontrib><description>Purpose
Laparoscopic sleeve gastrectomy (LSG) is estimated to be its most severe complication. An aggressive management with surgical reconstructive procedures can be proposed in patients in whom all the conservative endoscopic techniques fail. The purpose of the present study was to report our experience with Roux-en-Y gastric bypass (RYGBP) as treatment for the chronic leak after LSG.
Methods
Between January 2013 and July 2019, 17 consecutive patients underwent RYGBP for the treatment of chronic leak after LSG. The initial intervention, the endoscopic approach and the definitive surgical repair were carefully reviewed.
Results
Seventeen patients (13 women) with a median age of 39 years (24–67) with a median body mass index (BMI) of 40 kg/m
2
(30–52) underwent RYGBP for persistent fistula. Sixteen patients had their early LSG performed in another hospital. Eleven patients had an initial endoscopic treatment by pigtail drains following laparoscopic drainage and 6 other patients had the endoscopic stent as the first-choice line treatment. The overall average fistula diagnosis was done at 7.7 months (2–49 months) for 12 patients. For the rest of five patients, the procedure was performed almost in the acute setting (< 30 days). All procedures were performed by laparotomy but one. Five patients had a gastrojejunal anastomosis leak diagnosed by salivary flow in the drainage, but all patients were treated conservatively. No post-operative mortality was recorded.
Conclusions
Surgery should be considered in case of failure of the endoscopic treatment of chronic leak after LSG. Further research is needed to clearly identify the appropriate treatment, but in our experience, RYGBP approach including the leak site offers a low morbidity rate.</description><identifier>ISSN: 0960-8923</identifier><identifier>EISSN: 1708-0428</identifier><identifier>DOI: 10.1007/s11695-020-04646-6</identifier><identifier>PMID: 32920659</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Adult ; Aged ; Anastomotic Leak - etiology ; Anastomotic Leak - surgery ; Endoscopy ; Female ; Fistula ; Gastrectomy - adverse effects ; Gastric Bypass - adverse effects ; Gastrointestinal surgery ; Humans ; Laparoscopy ; Medicine ; Medicine & Public Health ; Middle Aged ; Obesity, Morbid - surgery ; Original Contributions ; Postoperative Complications - surgery ; Retrospective Studies ; Surgery ; Treatment Outcome ; Young Adult</subject><ispartof>Obesity surgery, 2021, Vol.31 (1), p.79-83</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020</rights><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-fa183988548258e9c03a192e82e58fc89de02f15591d9391b12fe49b0a29c963</citedby><cites>FETCH-LOGICAL-c375t-fa183988548258e9c03a192e82e58fc89de02f15591d9391b12fe49b0a29c963</cites><orcidid>0000-0002-2414-3511</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11695-020-04646-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11695-020-04646-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32920659$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Degrandi, Olivier</creatorcontrib><creatorcontrib>Nedelcu, Anamaria</creatorcontrib><creatorcontrib>Nedelcu, Marius</creatorcontrib><creatorcontrib>Simon, Agathe</creatorcontrib><creatorcontrib>Collet, Denis</creatorcontrib><creatorcontrib>Gronnier, Caroline</creatorcontrib><title>Roux-en-Y Gastric Bypass for the Treatment of Leak Following Sleeve Gastrectomy</title><title>Obesity surgery</title><addtitle>OBES SURG</addtitle><addtitle>Obes Surg</addtitle><description>Purpose
Laparoscopic sleeve gastrectomy (LSG) is estimated to be its most severe complication. An aggressive management with surgical reconstructive procedures can be proposed in patients in whom all the conservative endoscopic techniques fail. The purpose of the present study was to report our experience with Roux-en-Y gastric bypass (RYGBP) as treatment for the chronic leak after LSG.
Methods
Between January 2013 and July 2019, 17 consecutive patients underwent RYGBP for the treatment of chronic leak after LSG. The initial intervention, the endoscopic approach and the definitive surgical repair were carefully reviewed.
Results
Seventeen patients (13 women) with a median age of 39 years (24–67) with a median body mass index (BMI) of 40 kg/m
2
(30–52) underwent RYGBP for persistent fistula. Sixteen patients had their early LSG performed in another hospital. Eleven patients had an initial endoscopic treatment by pigtail drains following laparoscopic drainage and 6 other patients had the endoscopic stent as the first-choice line treatment. The overall average fistula diagnosis was done at 7.7 months (2–49 months) for 12 patients. For the rest of five patients, the procedure was performed almost in the acute setting (< 30 days). All procedures were performed by laparotomy but one. Five patients had a gastrojejunal anastomosis leak diagnosed by salivary flow in the drainage, but all patients were treated conservatively. No post-operative mortality was recorded.
Conclusions
Surgery should be considered in case of failure of the endoscopic treatment of chronic leak after LSG. Further research is needed to clearly identify the appropriate treatment, but in our experience, RYGBP approach including the leak site offers a low morbidity rate.</description><subject>Adult</subject><subject>Aged</subject><subject>Anastomotic Leak - etiology</subject><subject>Anastomotic Leak - surgery</subject><subject>Endoscopy</subject><subject>Female</subject><subject>Fistula</subject><subject>Gastrectomy - adverse effects</subject><subject>Gastric Bypass - adverse effects</subject><subject>Gastrointestinal surgery</subject><subject>Humans</subject><subject>Laparoscopy</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Obesity, Morbid - surgery</subject><subject>Original Contributions</subject><subject>Postoperative Complications - surgery</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0960-8923</issn><issn>1708-0428</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kMFO3DAQhq2qqLvQvkAPlaVeuBjG48SxjxTBgrTSSrAXTpY3O6FLk3ixE2DfntBsW4lDT6PRfPPP6GPsq4QTCVCcJim1zQUgCMh0poX-wKayADO0aD6yKVgNwlhUE3aY0gMASo34iU0UWgSd2ylb3IT-RVAr7vjMpy5uSv5jt_Up8SpE3v0kvozku4bajoeKz8n_4pehrsPzpr3ntzXRE42bVHah2X1mB5WvE33Z1yO2vLxYnl-J-WJ2fX42F6Uq8k5UXhpljckzg7khW4Ly0iIZpNxUpbFrAqxknlu5tsrKlcSKMrsCj7a0Wh2x4zF2G8NjT6lzzSaVVNe-pdAnh1mGGsAaNaDf36EPoY_t8NxAFYVBlFgMFI5UGUNKkSq3jZvGx52T4N5su9G2G2y737bd2xff9tH9qqH135U_egdAjUAaRu09xX-3_xP7CgyKiCU</recordid><startdate>2021</startdate><enddate>2021</enddate><creator>Degrandi, Olivier</creator><creator>Nedelcu, Anamaria</creator><creator>Nedelcu, Marius</creator><creator>Simon, Agathe</creator><creator>Collet, Denis</creator><creator>Gronnier, Caroline</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2414-3511</orcidid></search><sort><creationdate>2021</creationdate><title>Roux-en-Y Gastric Bypass for the Treatment of Leak Following Sleeve Gastrectomy</title><author>Degrandi, Olivier ; Nedelcu, Anamaria ; Nedelcu, Marius ; Simon, Agathe ; Collet, Denis ; Gronnier, Caroline</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-fa183988548258e9c03a192e82e58fc89de02f15591d9391b12fe49b0a29c963</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anastomotic Leak - etiology</topic><topic>Anastomotic Leak - surgery</topic><topic>Endoscopy</topic><topic>Female</topic><topic>Fistula</topic><topic>Gastrectomy - adverse effects</topic><topic>Gastric Bypass - adverse effects</topic><topic>Gastrointestinal surgery</topic><topic>Humans</topic><topic>Laparoscopy</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Obesity, Morbid - surgery</topic><topic>Original Contributions</topic><topic>Postoperative Complications - surgery</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Degrandi, Olivier</creatorcontrib><creatorcontrib>Nedelcu, Anamaria</creatorcontrib><creatorcontrib>Nedelcu, Marius</creatorcontrib><creatorcontrib>Simon, Agathe</creatorcontrib><creatorcontrib>Collet, Denis</creatorcontrib><creatorcontrib>Gronnier, Caroline</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Obesity surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Degrandi, Olivier</au><au>Nedelcu, Anamaria</au><au>Nedelcu, Marius</au><au>Simon, Agathe</au><au>Collet, Denis</au><au>Gronnier, Caroline</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Roux-en-Y Gastric Bypass for the Treatment of Leak Following Sleeve Gastrectomy</atitle><jtitle>Obesity surgery</jtitle><stitle>OBES SURG</stitle><addtitle>Obes Surg</addtitle><date>2021</date><risdate>2021</risdate><volume>31</volume><issue>1</issue><spage>79</spage><epage>83</epage><pages>79-83</pages><issn>0960-8923</issn><eissn>1708-0428</eissn><abstract>Purpose
Laparoscopic sleeve gastrectomy (LSG) is estimated to be its most severe complication. An aggressive management with surgical reconstructive procedures can be proposed in patients in whom all the conservative endoscopic techniques fail. The purpose of the present study was to report our experience with Roux-en-Y gastric bypass (RYGBP) as treatment for the chronic leak after LSG.
Methods
Between January 2013 and July 2019, 17 consecutive patients underwent RYGBP for the treatment of chronic leak after LSG. The initial intervention, the endoscopic approach and the definitive surgical repair were carefully reviewed.
Results
Seventeen patients (13 women) with a median age of 39 years (24–67) with a median body mass index (BMI) of 40 kg/m
2
(30–52) underwent RYGBP for persistent fistula. Sixteen patients had their early LSG performed in another hospital. Eleven patients had an initial endoscopic treatment by pigtail drains following laparoscopic drainage and 6 other patients had the endoscopic stent as the first-choice line treatment. The overall average fistula diagnosis was done at 7.7 months (2–49 months) for 12 patients. For the rest of five patients, the procedure was performed almost in the acute setting (< 30 days). All procedures were performed by laparotomy but one. Five patients had a gastrojejunal anastomosis leak diagnosed by salivary flow in the drainage, but all patients were treated conservatively. No post-operative mortality was recorded.
Conclusions
Surgery should be considered in case of failure of the endoscopic treatment of chronic leak after LSG. Further research is needed to clearly identify the appropriate treatment, but in our experience, RYGBP approach including the leak site offers a low morbidity rate.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>32920659</pmid><doi>10.1007/s11695-020-04646-6</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0002-2414-3511</orcidid></addata></record> |
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| ispartof | Obesity surgery, 2021, Vol.31 (1), p.79-83 |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Adult Aged Anastomotic Leak - etiology Anastomotic Leak - surgery Endoscopy Female Fistula Gastrectomy - adverse effects Gastric Bypass - adverse effects Gastrointestinal surgery Humans Laparoscopy Medicine Medicine & Public Health Middle Aged Obesity, Morbid - surgery Original Contributions Postoperative Complications - surgery Retrospective Studies Surgery Treatment Outcome Young Adult |
| title | Roux-en-Y Gastric Bypass for the Treatment of Leak Following Sleeve Gastrectomy |
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