SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY: THE EXPERIENCE OF A REFERRAL CENTER. Dr. W. JAMAL, DES, DESC Department of General Surgery King Abdulaziz University Hospital - Jeddah
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY: THE EXPERIENCE OF A REFERRAL CENTER. Dr. W. JAMAL, Prof. JM. CHEVALLIER Department of General & Digestive Surgery, HOPITAL EUROPEEN GEORGES POMPIDOU, APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY Sleeve Gastrectomy And Bariatric Surgery Popularity Indications Efficacity HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY Restrictive Procedure Frequency Effective weight loss Resolution of co-morbidity Effective < Difficult < Part Of BPD-DS 1st Step in super-super obese (BMI > 60) Stand alone HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY 13 Patients Transfered to HEGP after Sleeve M = 1, F = 12 Age 45.5 ( 35 – 60 ans) 3/13 SG (BPD-DS) 10/13 Sleeve (stand-alone) 5 after failed Band HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY Mrs. (1) 54 y.o Failed Band Sleeve Gastrectomy + BPD-DS Gastric leak Transferred to HEGP Imaging: Lt. Oeso – Pleural Fistula + Abces OR: Lavage + Drainage + J Feeding Thoracic Drainage HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY Mme (1) Decrease in Drainage Resume Oral Intake Discharged Home with Abdominal Drainage Readdmition; Respiratory Distress and Pneumopathy (Recurrence Oeso-Pleural Fistula) Antibiotic + Gastric Stent - Recurrence Oeso-Pleural Fistula OR: Total Gastectomy HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY Mrs. (2) 57 y.o Gastric Band 1999, Removal of Band 2002 Sleeve G + BPD-DS on 16/11/2005 Gastric Leak at D11 OR: Well managed, Well tolerated D18 upper GI Hg, OGD D34 (Hemorragic Choc), Transfusion 12 PRBC CT-Scan: Rupture of PseudoAnurism of SA Transfered to HEGP Embolisation Dischared 1m HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY Mrs. (3) 43 y.o Sleeve G 21 sept 2010 D2 Gastric Leak + Lt. sub-phrenic Abces OR: Drainage + J Feeding +Antibiotic Transferred to HEGP Sepsis (Pneumopathy) Failure Gastric Stent X 2 Clip OVESCO 15/12/2010 HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY Mrs (4) 60 y.o Sleeve G 22/7/2010 D3 Respiratory Distress Barium Meal: NO Leak CT-Scan: Perisplenic Fluid Collection Antibiotic + Transferred to HEGP CT-Scan2: Gastric Leak + Lt. Sub-Phrenic Collection + Lt. Pleural Effusion OR: Intubation of Leakage Site by T-tube Drain + Drainage + J Feeding Resume Oral Intake + Removal Of T-tube on October 2010 HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY Mrs (5) 30 y.o Sleeve Gastrectomy Post-Op OK, BUT…… Progressive Food Intake Intolerance 3 OGD Unremarkable Barium Meal …….. What to do ?? TWIST HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY Mrs (6) 35 y.o Failure Gastric Band Placement in 2008 21/10/2010 Failure Band ---} Sleeve Stabling Calibration tube + important Hg Conversion to Laparotomie, Anastomose Oeso-J Methylen Blue Test Positive ICU, Extubation at D1, fever 40, WBC 20000 CT-Scan D2, 2 Leaks Transferred to HEGP OR: Intubation of Leakage site (Spirale) Resume Oral Intake on March 2011 HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY DIAGNOSTIQUE N= Tx PseudoAnurism 1 Embolisation Gastro-Cutaneous Fistula 2 Clips Oeso-Gastric Leaks 5 3Drainage,1Clip, 1TG Calibration tube Stapling 1 TG Gastropleural Fistula 1 TG Abces 2 Drainage Twist 1 Stent Mean Length of Hospital Stay = 60 Jours ( 13, 135) Mean Number of Admission = 1.9 Hospi (1, 4) HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY CONCLUSION: Sleeve Gastrectomy is an effective weight loss procedure, despite its complications which are rare, it could be serious and considerably extend the legnth of hospital stay, with important fonctional and psychological consequences on patients. HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE PARIS-WISAM JAMAL