Laparoscopic sleeve gastrectomy - 7 years of own experience

Abstract

Introduction: Laparoscopic sleeve gastrectomy is a procedure frequently chosen by patients and surgeons that carries the risk of serious complications that are difficult to treat.

Aim: To describe the operations performed by us, considering complications and their management.

Material and methods: We performed 565 laparoscopic sleeve gastrectomies. Standard surgical technique was used. A 34 Fr calibration tube was used. An additional reinforcing suture was applied over the staple line.

Results: There was no need for conversion. In 7.79% of patients, infarcts of the posterior pole of the spleen were observed, whereas 8 patients (1.42%) developed gastric fistulas in the His angle region. In 3 cases, it led to development of an abscess in the posterior splenic pole region and 2 of these developed secondary gastric fistulas of typical location. In total, there were 5 deaths among the patients who had been operated on - 3 due to septic complications in the course of fistula, 1 due to encephalopathy and 1 as a result of myocardial infarction.

Conclusions: Sleeve gastrectomy is an effective and safe method of obesity treatment. The causes of the most severe complication - gastric fistula - cannot be established unequivocally. Infarcts of the posterior pole of the spleen, as a potential cause of fistulas, deserve particular attention. In our opinion, primary closure of the fistula by suturing is an inappropriate method of management, whereas the best results are obtained with temporary gastrointestinal tract prosthesis.

Keywords: complications; leak; sleeve; stent.

Photo 1

Infarcts of the posterior pole of the spleen