Iatrogenic injury of the intrathoracic oesophagus with bougie during sleeve gastrectomy

Abstract

One of the most popular procedures amongst obesity surgery is the sleeve gastrectomy. There is international consensus regarding the usage of bougie for sleeve gastrectomy calibration. Nevertheless, there is a dissociation between the number of oesophageal perforations reported for any other oesophageal/gastric operation that requires bougie (e.g., anti-reflux surgery, incidence 1.2%) and bariatric surgery, where this complication seems to be almost a myth. Interestingly enough, the number of bariatric procedures is much higher than any other oesophageal/gastric surgery. This suggests that oesophageal perforations in obesity surgery are underreported. We report a case of injury of the intrathoracic oesophagus with bougie that occurred during a sleeve gastrectomy. In the infrequent case that the perforation is diagnosed during surgery, primary repair during the same intervention is highly recommended. Videothoracoscopy might be an effective option in case of necessity. We were able to complete the sleeve gastrectomy without increasing morbidity.

Figure 1

Bougie (arrow) coming through the phrenoesophageal ligament

Figure 2

Dissection of the crura

Figure 3

Perforation detected below the arch of the azygos vein

Figure 4

Gastrografin swallow on post-operative day #4 showing no leaks. A significant oesophageal curvature was noticed