laparoscopic sleeve gastrectomy dr. ahmed refaey
TRANSCRIPT
![Page 1: Laparoscopic Sleeve Gastrectomy Dr. Ahmed Refaey](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e3b5503460f94b2d907/html5/thumbnails/1.jpg)
Laparoscopic SleeveGastrectomy
Dr. Ahmed Refaey
![Page 2: Laparoscopic Sleeve Gastrectomy Dr. Ahmed Refaey](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e3b5503460f94b2d907/html5/thumbnails/2.jpg)
• Laparoscopic sleeve gastrectomy (LSG) is the technique comprises removal of the great curvature of the stomach ,with a resection line parallel to the lesser curvature, so as to create a long tubular gastric remnant
![Page 3: Laparoscopic Sleeve Gastrectomy Dr. Ahmed Refaey](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e3b5503460f94b2d907/html5/thumbnails/3.jpg)
COMPLICATIONS
• Early COMPLICATIONS( within 2 weeks)• Hemorrhage• Staple line leak• Abscess• Delayed COMPLICATIONS• Stricture• Gastroesophageal reflux disease
![Page 4: Laparoscopic Sleeve Gastrectomy Dr. Ahmed Refaey](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e3b5503460f94b2d907/html5/thumbnails/4.jpg)
Complication DiagnosisHeamorrhage Physical findings, serial CBC
Leak Physical findings, UGI series
Abscess CT scan, ultrasound
Stricture Endoscopy, UGI series
GERD UGI series , endoscopy
![Page 5: Laparoscopic Sleeve Gastrectomy Dr. Ahmed Refaey](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e3b5503460f94b2d907/html5/thumbnails/5.jpg)
• Leak• Gastric leak is one of the most serious
complications of LSG• It occurs in up to 5% of patients following LSG.
![Page 6: Laparoscopic Sleeve Gastrectomy Dr. Ahmed Refaey](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e3b5503460f94b2d907/html5/thumbnails/6.jpg)
![Page 7: Laparoscopic Sleeve Gastrectomy Dr. Ahmed Refaey](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e3b5503460f94b2d907/html5/thumbnails/7.jpg)
![Page 8: Laparoscopic Sleeve Gastrectomy Dr. Ahmed Refaey](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e3b5503460f94b2d907/html5/thumbnails/8.jpg)
Gastrografin swallow studies demonstrating staple line leaks (a), focal leak (b), and leaks with contrast dissemination in the abdominalcavity
![Page 9: Laparoscopic Sleeve Gastrectomy Dr. Ahmed Refaey](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e3b5503460f94b2d907/html5/thumbnails/9.jpg)
CT images of staple line leak (a), left subphrenic gas and fluid collection (b), and drainage of the collection (c)
![Page 10: Laparoscopic Sleeve Gastrectomy Dr. Ahmed Refaey](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e3b5503460f94b2d907/html5/thumbnails/10.jpg)
• postoperative air-fluid collection adjacent to GE junction consistent with staple line leak
![Page 11: Laparoscopic Sleeve Gastrectomy Dr. Ahmed Refaey](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e3b5503460f94b2d907/html5/thumbnails/11.jpg)
An intraluminal stent for the treatment of a leak following laparoscopic sleeve gastrectomy.
![Page 12: Laparoscopic Sleeve Gastrectomy Dr. Ahmed Refaey](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e3b5503460f94b2d907/html5/thumbnails/12.jpg)
• Abscess• It usually presents with symptoms of abdom -
inal pain, fever/chills or nausea and vomiting.• If there are clinical suspicions, one should
obtain a computed tomography scan of the abdomen to rule out the presence of intra-abdominal abscess.
![Page 13: Laparoscopic Sleeve Gastrectomy Dr. Ahmed Refaey](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e3b5503460f94b2d907/html5/thumbnails/13.jpg)
• Perigastric abscess near the suture line and anterior to the left lobe of liver
![Page 14: Laparoscopic Sleeve Gastrectomy Dr. Ahmed Refaey](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e3b5503460f94b2d907/html5/thumbnails/14.jpg)
• CHRONIC COMPLICATIONS• Stricture• Gastroesophageal reflux disease
• An upper gastrointestinal study or endoscopy is usually diagnostic.
![Page 15: Laparoscopic Sleeve Gastrectomy Dr. Ahmed Refaey](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e3b5503460f94b2d907/html5/thumbnails/15.jpg)
• Stricture• It could present either acutely after surgery
due to tissue edema or more commonly in a delayed fashion.
• Presenting symptoms include food intolerance, dysphagia or nausea and vomiting.
•
![Page 16: Laparoscopic Sleeve Gastrectomy Dr. Ahmed Refaey](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e3b5503460f94b2d907/html5/thumbnails/16.jpg)
• Gastroesophageal reflux disease
![Page 17: Laparoscopic Sleeve Gastrectomy Dr. Ahmed Refaey](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e3b5503460f94b2d907/html5/thumbnails/17.jpg)
• Due to some technical difficulties during LSG, small part of stomach can be preserved either proximally or distally, giving radiological pattern which can be confused with leak.
![Page 18: Laparoscopic Sleeve Gastrectomy Dr. Ahmed Refaey](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e3b5503460f94b2d907/html5/thumbnails/18.jpg)
• The radiological patterns include:• tubular • superior pouch • Inferior pouch • inferior–superior pouch
![Page 19: Laparoscopic Sleeve Gastrectomy Dr. Ahmed Refaey](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e3b5503460f94b2d907/html5/thumbnails/19.jpg)
![Page 20: Laparoscopic Sleeve Gastrectomy Dr. Ahmed Refaey](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e3b5503460f94b2d907/html5/thumbnails/20.jpg)
Superior pouches that resemble leaks. a) Small pouch with irregular upper contour. b) Small pouch with a narrow neck c) Small oblong pouch with an irregular outer contour
![Page 21: Laparoscopic Sleeve Gastrectomy Dr. Ahmed Refaey](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e3b5503460f94b2d907/html5/thumbnails/21.jpg)
• In all patients, a UGI was routinely performed on POD 3 to exclude complications, primarily staple line leaks and strictures, and begin gradual fluid intake.
• If a leak was detected, further imaging investigation by CT was performed to confirm the finding and exclude abscess formation.
![Page 22: Laparoscopic Sleeve Gastrectomy Dr. Ahmed Refaey](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e3b5503460f94b2d907/html5/thumbnails/22.jpg)
![Page 23: Laparoscopic Sleeve Gastrectomy Dr. Ahmed Refaey](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e3b5503460f94b2d907/html5/thumbnails/23.jpg)
Thank You