STENTING OF THE GASTRIC TUBE WHEN THE GASTRIC LEAK AFTER SLEEVE GASTRECTOMY
About the author:
Slabkiy G. O., Usenko O. Y., Todurov I. M., Perekhrestenko O. V., Kalashnikov O. O., Kosiukhno S. V., Yakimets V. M., Tereshkevich I. S.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
The World Health Organization has described obesity as the greatest current threat to human health. Bariatric surgery is considered to be the most effective option for treatment obesity and related comorbidities. Sleeve gastrectomy is a recently developed technique for treating morbid obesity. Despite the low morbidity and mortality rates associated with sleeve gastrectomy, several perioperative complications may arise including bleeding, hernia, leaks and strictures. Among these conditions, leak is the most serious and feared complication following the procedure. Gastric leak is occur in 1% to 20% of patients after sleeve gastrectomy. A lot of publications exist concerning the treatment of gastric leak, but there is no single algorithm. The objective of our study was to determine the success of endoscopically stents in patients with staple line leaks after sleeve gastrectomy. The results of surgical treatment of 246 patients with morbid obesity are analyzed. Mean age was 43,5±13,7 years. There were 98 male and 148 female patients. Mean weight was 147,8±34,3 (106-246) kg. Mean initial body mass index was 46,3±11,6 (35–81,5) kg/m2. Mean excess of mass 79,3±36,3 (46-169) kg. Failure of the gastric tube stapler suture is to be the most threatening complication due to the difficulty of diagnosis, prevention and treatment. Staple line leaks occurred in six patients (2,4%). The diagnosis was confirmed by X-ray gastrography with urografin, upper gastrointestinal endoscopy and computed tomography scan. The time of diagnosis of gastric leak in 1 patient is 10 hours, in 5 patients – 78,8±59,1 (24-120) hours. After the diagnosis of complications in the first 6-12 hours of its occurrence the tactic of suturing the defect is reasonable. In case of extension of the diagnosis over 12 hours advantages of stenting tactics in comparison with the attempt to suture the defect are obvious. Although stent placement causes discomfort to the patient and needs advanced endoscopic skills in long-term it is apparent that it decreases healing time and hospital stay for the patients with gastric leak after sleeve gastrostomy.
obesity, sleeve gastrectomy, stapler suture failure of the gastric tube, stenting of the gastric tube
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 3 (145), 2018 year, 177-181 pages, index UDK 616-056.52:616-08-039.73:616-089.873-089.847