1. Laparoscopic Sleeve Gastrectomy Dr. Ahmed Refaey

2. 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

3. COMPLICATIONS Early COMPLICATIONS( within 2 weeks) Hemorrhage Staple line leak Abscess Delayed COMPLICATIONS Stricture Gastroesophageal reflux disease

4. ComplicationDiagnosis Heamorrhage Physical findings, serial CBC LeakPhysical findings, UGI series AbscessCT scan, ultrasound StrictureEndoscopy, UGI series GERDUGI series, endoscopy

5. Leak Gastric leak is one of the most serious complications of LSG It occurs in up to 5% of patients following LSG.

8. Gastrografin swallow studies demonstrating staple line leaks (a), focal leak (b), and leaks with contrast dissemination in the abdominal cavity

9. CT images of staple line leak (a), left subphrenic gas and fluid collection (b), and drainage of the collection (c)

10. postoperative air-fluid collection adjacent to GE junction consistent with staple line leak

11. An intraluminal stent for the treatment of a leak following laparoscopic sleeve gastrectomy.

12. 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.

13. Perigastric abscess near the suture line and anterior to the left lobe of liver

14. CHRONIC COMPLICATIONS Stricture Gastroesophageal reflux disease An upper gastrointestinal study or endoscopy is usually diagnostic.

15. 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.

16. Gastroesophageal reflux disease

17. 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.

18. The radiological patterns include: tubular superior pouch Inferior pouch inferior–superior pouch

20. 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

21. 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.

23. Thank You