From the Guidelines
Early complications of sleeve gastrectomy include bleeding, leaks, stenosis, and venous thromboembolism, which can be effectively managed with early detection and prompt intervention, potentially reducing morbidity and mortality 1.
Key Complications
- Bleeding: typically occurs within the first 24-48 hours postoperatively, presenting with tachycardia, hypotension, and decreasing hemoglobin levels
- Leaks: serious complications that usually develop within the first week, manifesting as fever, tachycardia, abdominal pain, and elevated inflammatory markers
- Stenosis: can occur at the incisura angularis or gastroesophageal junction, causing progressive dysphagia, nausea, and vomiting
- Venous thromboembolism: risk is elevated due to obesity and the surgical procedure itself
Management Strategies
- Early mobilization
- Adequate pain control
- Prophylactic antibiotics
- Thromboprophylaxis with low molecular weight heparin
- Close monitoring for complications, allowing for prompt intervention
- Proper surgical technique, including careful staple line reinforcement and meticulous hemostasis, to minimize complications 1
Importance of Collaboration
Collaboration between emergency surgeons, radiologists, endoscopists, and anesthesiologists is mandatory in the management of patients with early complications after sleeve gastrectomy, leading to focused management and decreased morbidity and mortality rates 1
From the Research
Early Complications of Sleeve Gastrectomy
- Early complications of sleeve gastrectomy include staple-line leakage, bleeding, and abscess formation 2
- Staple-line leakage is a potentially life-threatening complication that can occur after laparoscopic sleeve gastrectomy (LSG) 3, 4, 5
- The incidence of staple-line leakage varies from 1.2% to 5.0% in different studies 3, 5
- Bleeding is another common complication of LSG, with an incidence of up to 20% in some studies 6
- Reinforcement of the staple line with bovine pericardium or other methods can reduce the risk of staple-line leakage and bleeding 3, 6
Management of Early Complications
- Management of staple-line leaks after sleeve gastrectomy can include laparoscopic or open exploration, drainage, and endoscopic self-expandable covered stent, computed tomography-guided percutaneous drainage, or a self-expandable covered stent alone 5
- Medical support, including total parenteral nutrition and adapted antibiotics, is also important in the management of staple-line leaks 5
- Early detection and treatment of complications are crucial to prevent serious consequences, such as organ failure and mortality 4
Risk Factors for Early Complications
- Previous bariatric procedures may increase the risk of unfavorable evolution of LSG complications, including death or additional gastrectomy 4
- The use of different staple-line reinforcement methods can affect the risk of bleeding and leakage, but the optimal method is still a matter of controversy 3, 6