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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
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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
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SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE
GASTRECTOMY
HOPITAL EUROPEEN GEORGES POMPIDOU APHP Paris -
FRANCE
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SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE
GASTRECTOMY
Sleeve Gastrectomy And Bariatric Surgery
Popularity Indications Efficacity
HOPITAL EUROPEEN GEORGES POMPIDOU APHP Paris -
FRANCE
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SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE
GASTRECTOMY

• Sleeve Gastrectomy
• Restrictive Procedure
• Frequency
• Effective weight loss
• Resolution of co-morbidity

Effective lt
Difficult lt

• Part Of BPD-DS
• 1st Step in super-super obese (BMI gt 60)
• Stand alone

HOPITAL EUROPEEN GEORGES POMPIDOU APHP Paris -
FRANCE
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE
GASTRECTOMY
HOPITAL EUROPEEN GEORGES POMPIDOU APHP Paris -
FRANCE
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SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE
GASTRECTOMY
HOPITAL EUROPEEN GEORGES POMPIDOU APHP Paris -
FRANCE
PARIS-WISAM JAMAL