|
1
|
Vosburg RW, Nimeri A, Azagury D, Grover B, Noria S, Papasavas P, Carter J. ASMBS literature review on the treatment of marginal ulcers after metabolic and bariatric surgery. Surg Obes Relat Dis 2025; 21:1-8. [PMID: 39516065 DOI: 10.1016/j.soard.2024.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Accepted: 10/05/2024] [Indexed: 11/16/2024]
Abstract
Marginal ulcers (MUs) encompass a group of mucosal disruptions and subsequent inflammatory changes and their sequala found after Roux-en-Y gastric bypass (RYGB) oneanastomosis gastric bypass (OAGB), and, less commonly, after biliopancreatic diversion with duodenal switch (BPD/DS) or single anastomosis duodeno-ileostomy with sleeve gastrectomy (SADI-S). Prevalence of MU after RYGB ranges from .6%-16%. This review summarizes the current knowledge about the treatment options available for MU after MBS for providers who treat them.
Collapse
Affiliation(s)
| | | | - Dan Azagury
- Stanford School of Medicine, Palo Alto, California
| | | | - Sabrena Noria
- The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | | | - Jonathan Carter
- University of California, San Francisco, San Francisco, California
| |
Collapse
|
|
2
|
Almayouf M, Alqahtani A. A case report of an early gastrocolic fistula following Roux-en Y gastric bypass, a unique and uncommon complication. Int J Surg Case Rep 2024; 122:110191. [PMID: 39154564 PMCID: PMC11378216 DOI: 10.1016/j.ijscr.2024.110191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 08/13/2024] [Accepted: 08/15/2024] [Indexed: 08/20/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Gastrocolic fistula (GCF) following Roux-en-Y gastric bypass (RYGB) is uncommon. Usually it presents late with nonspecific symptoms and originates from the gastrojejunostomy (GJ). Management of such complication can be surgical, but endoscopic management can be implemented in selected patients. To our knowledge this is the first case reporting an early GCF originating from gastric pouch successfully managed with endoscopic stenting. CASE PRESENTATION A 54-year-old female, with surgical history of open vertical band gastroplasty (VBG), complaining of weight regain and reflux symptoms. The plan was to laparoscopically convert VBG to RYGB. Two weeks after, she presented unusually with only fatigue and epigastric pain. CLINICAL DISCUSSION Leak was suspected and needed to be ruled out. The patient was presenting in an unusual presentation, i.e. vitally stable and only fatigued. Workup including laboratories, computed tomography, and endoscopy confirmed staple line disruption with development of early GCF. Management included endoscopic fully covered stent, total preantral nutrition. CONCLUSION With a well-trained team and the availability of expertise, GCF can be managed with endoscopic stents.
Collapse
Affiliation(s)
- Mohammad Almayouf
- Prince Sattam bin Abdulaziz University, College of Medicine, Department of Surgery, Alkharj, Saudi Arabia.
| | - Awadh Alqahtani
- King Saud University, College of Medicine, Department of Surgery, Riyadh, Saudi Arabia
| |
Collapse
|
|
3
|
Hage K, Sawma T, Jawhar N, Bartosiak K, Vargas EJ, Abu Dayyeh BK, Ghanem OM. Revisional Bariatric Surgery After Roux-en-Y Gastric Bypass for Bile Reflux: a Single-Center Long-Term Cohort Study. Obes Surg 2024; 34:2420-2430. [PMID: 38861123 DOI: 10.1007/s11695-024-07355-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE Revisional bariatric surgery (RBS) after primary Roux-en-Y gastric bypass (RYGB) is indicated for the efficient management of specific complications such as bile reflux. Published literature on this topic remains scarce as we aim to evaluate the long-term outcomes (10 years) of RBS for bile reflux after RYGB. MATERIAL AND METHODS We conducted a single-center retrospective study of patients who underwent primary RYGB complicated by bile reflux and had RBS between 2008 and 2023. Our cohort was divided into two groups based on the etiology of bile reflux. Long-term surgical outcomes and nutritional status were reported and compared between the groups. RESULTS A total of 41 patients (100% primary RYGB; 90.2% female, 97.6% white) were included. 56.1% (n = 23) of patients underwent Roux limb lengthening and the remaining 43.9% (n = 18) had a gastrogastric fistula takedown, with no significant differences in terms of intraoperative complications, estimated blood loss (p = 0.616), length of hospital stay (p = 0.099), and postoperative complications between the two groups. Long-term resolution of obesity-related medical conditions was demonstrated for all the evaluated comorbidities. Lastly, there was no reported mortality, bile reflux recurrence, or micro- and macro-nutrient deficiencies over the total follow-up period of 10 years. CONCLUSION In our cohort, RBS after a primary RYGB for bile reflux management demonstrated safe and efficient short- and long-term surgical outcomes without any reported bile reflux recurrence or mortality. Adequate supplementation and close patient follow-up remain essential to decrease the morbidity and mortality associated with RBS as further studies are required to support our findings.
Collapse
Affiliation(s)
- Karl Hage
- Metabolic and Abdominal Wall Reconstructive Surgery, Department of Surgery, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA
| | - Tedy Sawma
- Metabolic and Abdominal Wall Reconstructive Surgery, Department of Surgery, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA
| | - Noura Jawhar
- Metabolic and Abdominal Wall Reconstructive Surgery, Department of Surgery, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA
| | - Katarzyna Bartosiak
- Metabolic and Abdominal Wall Reconstructive Surgery, Department of Surgery, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, National Research Institute, 04-141, Warsaw, Poland
| | - Eric J Vargas
- Department of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, MN, 55905, USA
| | - Barham K Abu Dayyeh
- Department of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, MN, 55905, USA
| | - Omar M Ghanem
- Metabolic and Abdominal Wall Reconstructive Surgery, Department of Surgery, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA.
| |
Collapse
|
|
4
|
Patel K, Perdue J, Varre J, Serapiglia V, Rizzo A, Sonnanstine T. Operative technique for a successful laparoscopic en-bloc resection of gastrogastric fistula following roux-en-Y gastric bypass. J Surg Case Rep 2023; 2023:rjad569. [PMID: 37854523 PMCID: PMC10581709 DOI: 10.1093/jscr/rjad569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/11/2023] [Indexed: 10/20/2023] Open
Abstract
Gastrogastric fistulas are rare complications following Roux-en-Y gastric bypass surgery and are characterized by a fistulous connection between the gastric pouch and the remnant stomach. The presentation is often variable and a high-index of suspicion must be maintained for accurate and timely diagnosis. In this case report, we provide a detailed review of the technical steps taken to successfully resect a gastrogastric fistula en-bloc laparoscopically with an unremarkable post-operative course.
Collapse
Affiliation(s)
- Krishna Patel
- General Surgery, OhioHealth Riverside Methodist Hospital, Columbus 43214, United States
| | - Jordyn Perdue
- General Surgery, OhioHealth Riverside Methodist Hospital, Columbus 43214, United States
| | - Jaya Varre
- General Surgery, OhioHealth Riverside Methodist Hospital, Columbus 43214, United States
| | - Vinnie Serapiglia
- General Surgery, OhioHealth Riverside Methodist Hospital, Columbus 43214, United States
| | - Anthony Rizzo
- General Surgery, OhioHealth Riverside Methodist Hospital, Columbus 43214, United States
| | - Thomas Sonnanstine
- General Surgery, OhioHealth Riverside Methodist Hospital, Columbus 43214, United States
| |
Collapse
|
|
5
|
Ghanem OM, Ghazi R, Abdul Razzak F, Bazerbachi F, Ravi K, Khaitan L, Kothari SN, Abu Dayyeh BK. Turnkey algorithmic approach for the evaluation of gastroesophageal reflux disease after bariatric surgery. Gastroenterol Rep (Oxf) 2023; 11:goad028. [PMID: 37304555 PMCID: PMC10256627 DOI: 10.1093/gastro/goad028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/12/2022] [Accepted: 02/01/2023] [Indexed: 06/13/2023] Open
Abstract
Bariatric surgeries are often complicated by de-novo gastroesophageal reflux disease (GERD) or worsening of pre-existing GERD. The growing rates of obesity and bariatric surgeries worldwide are paralleled by an increase in the number of patients requiring post-surgical GERD evaluation. However, there is currently no standardized approach for the assessment of GERD in these patients. In this review, we delineate the relationship between GERD and the most common bariatric surgeries: sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), with a focus on pathophysiology, objective assessment, and underlying anatomical and motility disturbances. We suggest a stepwise algorithm to help diagnose GERD after SG and RYGB, determine the underlying cause, and guide the management and treatment.
Collapse
Affiliation(s)
- Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Rabih Ghazi
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Fateh Bazerbachi
- CentraCare, Interventional Endoscopy Program, St Cloud Hospital, St Cloud, MN, USA
| | - Karthik Ravi
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Leena Khaitan
- Department of Surgery, Case Western Reserve University, Cleveland, OH, USA
| | | | - Barham K Abu Dayyeh
- Corresponding author. Division of Gastroenterology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Tel: +1-507-284-2511; Fax: +1-507-284-0538;
| |
Collapse
|
|
6
|
Altieri MS, Rogers A, Afaneh C, Moustarah F, Grover BT, Khorgami Z, Eisenberg D. Bariatric Emergencies for the General Surgeon. Surg Obes Relat Dis 2023; 19:421-433. [PMID: 37024348 DOI: 10.1016/j.soard.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 02/04/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Maria S Altieri
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Ann Rogers
- Department of Surgery, Hershey School of Medicine, Penn State University, Hershey, Pennsylvania
| | | | - Fady Moustarah
- Department of Surgery, Beaumont Hospital, Bloomfield Hills, Michigan
| | - Brandon T Grover
- Department of Surgery, Gundersen Lutheran Medical Center, La Crosse, Wisconsin
| | - Zhamak Khorgami
- Department of Surgery, University of Oklahoma College of Community Medicine, Tulsa, Oklahoma; Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Dan Eisenberg
- Department of Surgery, Stanford School of Medicine and VA Palo Alto Health Care System, Palo Alto, California
| |
Collapse
|
|
7
|
Schairer J, Fahad H. Endoscopy in the Surgically Altered Bowel. Gastrointest Endosc Clin N Am 2022; 32:777-799. [PMID: 36202516 DOI: 10.1016/j.giec.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Improved utilization of surgical interventions to improve patient outcomes has led to an increased need to endoscopically evaluate and treat the bowel after surgery. The best outcomes are attained when the endoscopist coordinates with the surgeon, and in some cases the pathologist or radiologist to plan the procedure. Understanding the anatomy and pathology anticipated can allow planning for sedation, bowel cleanse and equipment needed. Surgically altered anatomy can create challenges that with planning can be overcome. This article will review how to prepare and navigate several of the most commonly encountered surgical interventions.
Collapse
Affiliation(s)
- Jason Schairer
- Division of Gastroenterology, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
| | - Hamna Fahad
- Division of Gastroenterology, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| |
Collapse
|
|
8
|
Shetye B, Hamilton FR, Bays HE. Bariatric surgery, gastrointestinal hormones, and the microbiome: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022. OBESITY PILLARS 2022; 2:100015. [PMID: 37990718 PMCID: PMC10661999 DOI: 10.1016/j.obpill.2022.100015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 03/26/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) is intended to provide clinicians an overview of bariatric surgery (i.e., bariatric procedures that improve metabolic disease are often termed "metabolic and bariatric surgery"), gastrointestinal hormones, and the microbiome as they relate to patients with obesity. Methods The scientific information for this CPS is based upon published scientific citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership. Results This CPS includes the pros and cons of the most common types of bariatric procedures; the roles of gastrointestinal (GI) hormones in regulating hunger, digestion, and postabsorptive nutrient metabolism; and the microbiome's function and relationship with body weight. This CPS also describes patient screening for bariatric surgery, patient care after bariatric surgery, and treatment of potential nutrient deficiencies before and after bariatric surgery. Finally, this CPS explores the interactions between bariatric surgery, GI hormones, and the microbiome. Conclusions This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) regarding bariatric surgery, gastrointestinal hormones, and the microbiome is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity. Implementation of appropriate care before and after bariatric surgery, as well as an awareness of GI hormones and the microbiome, may improve the health of patients with obesity, especially patients with adverse fat mass and adiposopathic metabolic consequences.
Collapse
Affiliation(s)
- Bharti Shetye
- Diplomate American Board of Obesity Medicine, Medical Director, Dr. Abby's Weight Management Clinic, 6101 Webb Road, Suite 207, Tampa, FL, 33615, USA
| | - Franchell Richard Hamilton
- Diplomate American Board of Obesity Medicine, A Better Weigh Center, 8865 Davis Blvd Ste 100, Keller, TX, 76248, USA
| | - Harold Edward Bays
- Diplomate American Board of Obesity Medicine, Louisville Metabolic and Atherosclerosis Research Center, University of Louisville School of Medicine, 3288 Illinois Avenue, Louisville, KY, 40213, USA
| |
Collapse
|
|
9
|
Larsen M, Kozarek R. Therapeutic endoscopy for the treatment of post-bariatric surgery complications. World J Gastroenterol 2022; 28:199-215. [PMID: 35110945 PMCID: PMC8776527 DOI: 10.3748/wjg.v28.i2.199] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/08/2021] [Accepted: 12/31/2021] [Indexed: 02/06/2023] Open
Abstract
Obesity rates continue to climb worldwide. Obesity often contributes to other comorbidities such as type 2 diabetes, hypertension, heart disease and is a known risk factor for many malignancies. Bariatric surgeries are by far the most invasive treatment options available but are often the most effective and can result in profound, durable weight loss with improvement in or resolution of weight associated comorbidities. Currently performed bariatric surgeries include Roux-en-Y gastric bypass, sleeve gastrectomy, and laparoscopic gastric banding. These surgeries are associated with significant weight loss, but also with significant rates of major complications. The complexity of these patients and surgical anatomies makes management of these complications by a multidisciplinary team critical for optimal outcomes. Minimally invasive treatments for complications are typically preferred because of the high risk associated with repeat operations. Endoscopy plays a large role in both the diagnosis and the management of complications. Endoscopy can provide therapeutic interventions for many bariatric surgical complications including anastomotic strictures, anastomotic leaks, choledocholithiasis, sleeve stenosis, weight regain, and eroded bands. Endoscopists should be familiar with the various surgical anatomies as well as the various therapeutic options available. This review article serves to delineate the current role of endoscopy in the management of complications after bariatric surgery.
Collapse
Affiliation(s)
- Michael Larsen
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA 98101, United States
| | - Richard Kozarek
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA 98101, United States
| |
Collapse
|
|
10
|
Dolan RD, Bazarbashi AN, Jirapinyo P, Thompson CC. Test Characteristics of Abdominal Computed Tomography for the Diagnosis of Gastro-gastric Fistula in Patients with Roux-en-Y Gastric Bypass. Obes Surg 2021; 31:2471-2476. [PMID: 33619691 DOI: 10.1007/s11695-021-05296-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/04/2021] [Accepted: 02/10/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Gastrogastric fistulae (GGF) occur in 1-6% of Roux-en-Y gastric bypass (RYGB) patients. Many patients undergo abdominal computed tomography (CT) as an initial test owing to its wide availability; however, CT diagnostic accuracy for GGF is unclear. Our aim was to evaluate test characteristics of abdominal CT compared to upper gastrointestinal series (UGI) and esophagogastroduodenoscopy (EGD) for diagnosing GGF using surgery as a gold standard. METHODS Retrospective review of RYGB patients who underwent abdominal CT with oral contrast within 1 year. Demographics, weight parameters, and symptoms were collected. Surgery within 1 year of the diagnostic tests was included as the gold standard comparison. Primary outcomes included CT sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DA) for GGF. RESULTS One hundred thirty-seven patients were included, where 42 (30.1%) had positive CT and 95 (69.3%) had negative CT for GGF. Compared to surgical confirmation, CT abdomen with PO contrast had sensitivity of 73.1% (59-84.4), specificity of 95.2% (88.3-98.7), PPV 90.5% (77.4-97.3), NPV of 85.1% (76.3-91.2), and DA 89.7%. UGI series had sensitivity of 58.5% (42.1-73.7), specificity of 98.8% (93.5-99.9), PPV of 96% (79.7-99.9), NPV of 82.8% (73.9-89.7), and diagnostic accuracy (DA) of 85.4%. EGD had sensitivity of 78.3% (63.6-89.1), specificity of 98.8% (93.5-99.9), PPV 97.3 (85.8-99.9), and DA 91.5%. There were no significant differences in diagnostic test characteristics among modalities. CONCLUSIONS Abdominal CT with oral contrast has similar diagnostic test characteristics to UGI and EGD at detecting GGF when using surgical diagnosis as a gold standard.
Collapse
Affiliation(s)
- Russell D Dolan
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital. Harvard Medical School, Boston, MA, 02115, USA
| | - Ahmad Najdat Bazarbashi
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital. Harvard Medical School, Boston, MA, 02115, USA
| | - Pichamol Jirapinyo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital. Harvard Medical School, Boston, MA, 02115, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital. Harvard Medical School, Boston, MA, 02115, USA.
| |
Collapse
|
|
11
|
Gaspar JRR, Marques P, Mesquita I, Marcos M, Santos J, Nogueira C. Laparoscopic treatment of a gastro-gastric fistula after Roux-en-Y gastric bypass-report of two cases. J Surg Case Rep 2020; 2020:rjaa478. [PMID: 33343864 PMCID: PMC7732258 DOI: 10.1093/jscr/rjaa478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/24/2020] [Indexed: 11/13/2022] Open
Abstract
The most frequently performed bariatric surgery is the laparoscopic Roux-en-Y gastric bypass (LRYGB). An uncommon complication of LRYGB is gastro-gastric fistula (GGF). Possible causes of GGF include incomplete transection of the stomach during the initial surgery, staple-line leaks in the post-operative period and marginal ulcers. The optimal management of GGF is still under debate, with medical, endoscopic and surgical treatment modalities available. The authors present two cases of a GGF successfully managed with a laparoscopic surgical approach, after failed medical and endoscopic treatment.
Collapse
Affiliation(s)
| | - Paula Marques
- General Surgery, Department of Surgery, Centro Hospitalar e Universitário do Porto (CHUP), Oporto, Portugal
| | - Isabel Mesquita
- General Surgery, Department of Surgery, Centro Hospitalar e Universitário do Porto (CHUP), Oporto, Portugal
| | - Mário Marcos
- General Surgery, Department of Surgery, Centro Hospitalar e Universitário do Porto (CHUP), Oporto, Portugal
| | - Jorge Santos
- General Surgery, Department of Surgery, Centro Hospitalar e Universitário do Porto (CHUP), Oporto, Portugal
| | - Carlos Nogueira
- General Surgery, Department of Surgery, Centro Hospitalar e Universitário do Porto (CHUP), Oporto, Portugal
| |
Collapse
|
|
12
|
Alyaqout K, Almazeedi S, Alhaddad M, Efthimiou E, Loureiro MDP. GASTROGASTRIC FISTULA AFTER ROUX-EN-Y GASTRIC BYPASS: A CASE REPORT AND REVIEW OF LITERATURE. ACTA ACUST UNITED AC 2020; 33:e1509. [PMID: 32844882 PMCID: PMC7448858 DOI: 10.1590/0102-672020190001e1509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/23/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Khaled Alyaqout
- Chelsea and Westminster Hospital Trust, London, United Kingdom
| | | | | | | | | |
Collapse
|
|
13
|
Rizk S, El Hajj Moussa W, Assaker N, Makhoul E, Chelala E. Case report about the management of a late Gastro-Gastric Fistula after Laparoscopic Gastric Bypass, with the finding of an unexpected foreign body. Int J Surg Case Rep 2020; 67:117-119. [PMID: 32062113 PMCID: PMC7016345 DOI: 10.1016/j.ijscr.2020.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 12/26/2019] [Accepted: 01/08/2020] [Indexed: 12/12/2022] Open
Abstract
Anemia & Weight Regain are possible signs of Gastrogastric fistula post RYGB. Preventive Gastrectomy is indicated in presence of Dysplasia in the Gastric Remnant. Orogastric Tube Stapling can be immediately detected or discovered years after RYGB. A series of protocols should be respected to avoid Orogastric Tube Stapling. Background Gastro-Gastric Fistula is a rare but potentially serious complication of Roux-en-Y Gastric Bypass. Orogastric tube stapling is an adverse bariatric surgery iatrogenic complication that surgeons should be aware of and that has rarely been described. Clinical case A 51-year-old patient, operated in our University Hospital Center of a Gastric Bypass 3 years ago, presented on consultation with anemia and weight regain (BMI 36). An upper Gastrointestinal (GI) endoscopy showed a Gastro-Gastric Fistula and visualized the tip of a Faucher tube fixed in the blind pouch and an erosive ulceration on the gastrojejunal anastomosis. Multiple biopsies showed a low-grade dysplasia in the remnant stomach. A subtotal gastrectomy was performed with refashioning of the gastrojejunal anastomosis. Discussion Anemia and weight regain, with or without the association of marginal ulcers are the most common signs of Gastro-Gastric Fistula after Gastric Bypass (1–6%). Surgical treatment remains the standard of care and should be tailored to the size and location of the fistula and the status of the gastrojejunal anastomosis. Orogastric tube perioperative complications are rare occurrences during bariatric surgery and not reported at a later stage. They can be associated with significant morbidity. Prevention strategies must be taken and standardized to prevent such events. Conclusion The surgical option remains the standard of treatment and can be performed safely in Gastro-Gastric Fistula Type II. Orogastric tube accidental complications should be identified preferably perioperatively and measures of prevention should be implied to avoid such events.
Collapse
Affiliation(s)
- Simon Rizk
- Department of General Surgery, University Hospital Notre Dame des Secours, Byblos-Lebanon affiliated to Faculty of Medicine and Medical Sciences of the Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Wissam El Hajj Moussa
- Department of General Surgery, University Hospital Notre Dame des Secours, Byblos-Lebanon affiliated to Faculty of Medicine and Medical Sciences of the Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Nidal Assaker
- Department of General Surgery, University Hospital Notre Dame des Secours, Byblos-Lebanon affiliated to Faculty of Medicine and Medical Sciences of the Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Elias Makhoul
- Department of Gastroenterology, University Hospital Notre Dame des Secours, Byblos-Lebanon affiliated to Faculty of Medicine and Medical Sciences of the Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Elie Chelala
- Department of General Surgery, University Hospital Notre Dame des Secours, Byblos-Lebanon affiliated to Faculty of Medicine and Medical Sciences of the Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.
| |
Collapse
|
|
14
|
Lopez Luciano MJ, Then EO, Brana CJ, Ofosu A, Gaduputi V. Spontaneous Gastrojejunal Fistulization after Roux-en-Y Bypass Surgery: A Case Report and Review of Literature. Cureus 2019; 11:e5035. [PMID: 31501727 PMCID: PMC6721868 DOI: 10.7759/cureus.5035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Fistula development is an uncommon but well-recognized complication following Roux-en-Y gastric bypass (RYGB). The broad spectrum of clinical presentation represents a challenge at the time of diagnosis. We present the case of a patient who developed gastrojejunal fistulization after gastric bypass surgery.
Collapse
Affiliation(s)
| | - Eric O Then
- Internal Medicine, St. Barnabas Hospital Health System, Bronx, USA
| | | | - Andrew Ofosu
- Internal Medicine: Gastroenterology, The Brooklyn Hospital Center, Affiliate of the Mount Sinai Hospital, New York, USA
| | - Vinaya Gaduputi
- Internal Medicine, St. Barnabas Hospital Health System, Bronx, USA
| |
Collapse
|
|
15
|
Badurdeen DS, Lamond K, Gandsas A, Kumbhari V. Endoscopic strategies for the treatment of postbariatric surgery leaks and fistulas. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2019. [DOI: 10.1016/j.tgie.2019.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
|
16
|
Novel endoscopic modalities for closure of perforations, leaks, and fistula in the gastrointestinal tract. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2019. [DOI: 10.1016/j.tgie.2019.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
|
17
|
Jafri SA, Jay Roberts DO, Smith A. Successful management of early gastrogastric fistula using fully covered esophageal stent. Surg Obes Relat Dis 2018; 14:1911-1913. [PMID: 30545597 DOI: 10.1016/j.soard.2018.09.484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Saad A Jafri
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Forth Worth, Texas
| | | | | |
Collapse
|
|
18
|
Chahine E, Kassir R, Dirani M, Joumaa S, Debs T, Chouillard E. Surgical Management of Gastrogastric Fistula After Roux-en-Y Gastric Bypass: 10-Year Experience. Obes Surg 2018; 28:939-944. [PMID: 28983751 DOI: 10.1007/s11695-017-2949-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Gastrogastric fistula (GGF) occurs in 1-6% of patients who undergo Roux-en-Y gastric bypass (RYGB) for morbid obesity. The pathophysiology may be related to gastric ischemia, fistula, or ulcer. OBJECTIVES The purposes of the study are to describe the principles of management and to review the literature of this uncommon complication. SETTING The setting of this study is University Hospital, France. MATERIALS AND METHODS We conducted a retrospective review of all patients' records with a diagnosis of GGF after RYGB between January 2004 and November 2014. RESULTS During the study period, 1273 patients had RYGB for morbid obesity. Fifteen patients presented with a symptomatic GGF (1.18%). The average interval from surgery to presentation was 28 months (22-62). A history of marginal ulcer or anastomotic leak was present in nine patients (60%). The most common presentation was weight regain (80%), followed by pain (73.3%). Two types of fistulas were identified, an exclusively GGF (high) and a gastro-jejuno-gastric fistula (low). High GGF, frequently associated with dilatation of the gastric pouch, was treated by a sleeve of the pouch and sleeve resection of the remnant stomach (nine patients). Low GGF was treated with gastric resection coupled with a revision of the gastrojejunal anastomosis (six patients). All patients were treated laparoscopically with no conversion to laparotomy. The average length of postoperative hospital stay was 5.2 days (range 3-10). CONCLUSION GGF after RYGB is a rare complication. Its pathophysiology remains unclear. Surgical management is the definitive treatment.
Collapse
Affiliation(s)
- Elias Chahine
- Department of General and Minimally Invasive Surgery, Paris Poissy Medical Center, Poissy, France
| | - Radwan Kassir
- Department of General Surgery, CHU Nord Hospital, Jean Monnet University, Avenue Albert Raimond, 42270, Saint Etienne, France.
| | - Mazen Dirani
- Department of General and Minimally Invasive Surgery, Paris Poissy Medical Center, Poissy, France
| | - Saadeddine Joumaa
- Department of General and Minimally Invasive Surgery, Paris Poissy Medical Center, Poissy, France
| | - Tarek Debs
- Department of General Surgery, CHU Archet, Nice, France
| | - Elie Chouillard
- Department of General and Minimally Invasive Surgery, Paris Poissy Medical Center, Poissy, France
| |
Collapse
|
|
19
|
Common postoperative anatomy that requires special endoscopic consideration. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2018. [DOI: 10.1016/j.tgie.2018.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
|
20
|
Bowles-Cintron RJ, Perez-Ginnari A, Martinez JM. Endoscopic management of surgical complications. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2018. [DOI: 10.1016/j.tgie.2018.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
|
21
|
Nguyen J, Siksik JM, Genser L. Gastro-gastric fistula after gastric bypass. J Visc Surg 2018; 155:431-432. [PMID: 30093308 DOI: 10.1016/j.jviscsurg.2018.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- J Nguyen
- Service de chirurgie digestive hépatobilio-pancréatique et transplantation hépatique, groupe hospitalier Pitié-Salpêtrière, Assistance publique des hôpitaux de Paris (AP-HP), 47-83, boulevard de l'hôpital, 75013 Paris, France
| | - J M Siksik
- Service de chirurgie digestive hépatobilio-pancréatique et transplantation hépatique, groupe hospitalier Pitié-Salpêtrière, Assistance publique des hôpitaux de Paris (AP-HP), 47-83, boulevard de l'hôpital, 75013 Paris, France
| | - L Genser
- Service de chirurgie digestive hépatobilio-pancréatique et transplantation hépatique, groupe hospitalier Pitié-Salpêtrière, Assistance publique des hôpitaux de Paris (AP-HP), 47-83, boulevard de l'hôpital, 75013 Paris, France.
| |
Collapse
|
|
22
|
Alban EAD, García CA, Ospina LM, Munevar HE. Imaging after Bariatric Surgery: When Interpretation Is a Challenge, from Normal to Abnormal. Obes Surg 2018; 28:2923-2931. [DOI: 10.1007/s11695-018-3334-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
|
23
|
Mala T, Høgestøl I. Abdominal Pain After Roux-En-Y Gastric Bypass for Morbid Obesity. Scand J Surg 2018; 107:277-284. [DOI: 10.1177/1457496918772360] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background and Aims: Roux-en-Y gastric bypass is widely used as treatment of morbid obesity. Weight loss, effects on obesity-related co-morbidities and quality of life are well documented post Roux-en-Y gastric bypass. Other outcome measures are less well studied. This review explores aspects of prevalence, diagnostic evaluations, etiology, and treatment of abdominal pain specific to Roux-en-Y gastric bypass. Methods: The review is based on PubMed searches and clinical experience with Roux-en-Y gastric bypass. Symptoms in the early postoperative phase (<30 days) were not included. Results: Based on limited evidence, up to about 30% of the patients may perceive recurrent abdominal pain post Roux-en-Y gastric bypass in the long term. A substantial subset of patients will need health-care evaluation for acute abdominal pain and hospital admission. The etiology of abdominal pain is heterogeneous and includes gallstone-related disease, intestinal obstruction, anastomotic ulcerations and strictures, intestinal dysmotility, dysfunctional eating, and food intolerance. Surgical treatment and guidance on diet and eating habits may allow symptom relief. The cause of pain remains undefined for a subset of patients. Impact of abdominal pain post Roux-en-Y gastric bypass on the perception of well-being, quality of life, and patient satisfaction with the procedure needs to be further evaluated and may be influenced by complex interactions between new symptoms post Roux-en-Y gastric bypass and relief of pre-existing symptoms. Conclusion: Abdominal pain should be part of follow-up consultations post Roux-en-Y gastric bypass. Future studies should focus on combined evaluations before and after surgery to enlighten potential casual relationships between abdominal pain and Roux-en-Y gastric bypass.
Collapse
Affiliation(s)
- T. Mala
- Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - I. Høgestøl
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
|
24
|
|
|
25
|
Affiliation(s)
- Allison R Schulman
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
|
26
|
|
|
27
|
Schulman AR, Thompson CC. Complications of Bariatric Surgery: What You Can Expect to See in Your GI Practice. Am J Gastroenterol 2017; 112:1640-1655. [PMID: 28809386 DOI: 10.1038/ajg.2017.241] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 06/27/2017] [Indexed: 02/06/2023]
Abstract
Obesity is one of the most significant health problems worldwide. Bariatric surgery has become one of the fastest growing operative procedures and has gained acceptance as the leading option for weight-loss. Despite improvement in the performance of bariatric surgical procedures, complications are not uncommon. There are a number of unique complications that arise in this patient population and require specific knowledge for proper management. Furthermore, conditions unrelated to the altered anatomy typically require a different management strategy. As such, a basic understanding of surgical anatomy, potential complications, and endoscopic tools and techniques for optimal management is essential for the practicing gastroenterologist. Gastroenterologists should be familiar with these procedures and complication management strategies. This review will cover these topics and focus on major complications that gastroenterologists will be most likely to see in their practice.
Collapse
Affiliation(s)
- Allison R Schulman
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
|
28
|
Weiss J, Pomschar A, Rist C, Neumaier K, Li M, Flatz W, Thierfelder K, Notohamiprodjo M. Feasibility of optimized ultralow-dose pulsed fluoroscopy for upper gastrointestinal tract examinations: a phantom study with clinical correlation. Radiol Med 2017; 122:822-828. [DOI: 10.1007/s11547-017-0793-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
|
|
29
|
Pang AJ, Hagen J. Laparoscopic approach to a bleeding marginal ulcer fistulized to the gastric remnant in a patient post Roux-en-Y gastric bypass. Surg Obes Relat Dis 2017; 13:1451-1452. [PMID: 28583813 DOI: 10.1016/j.soard.2017.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 04/25/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Allison J Pang
- Department of General Surgery, University of Toronto, Toronto, Canada.
| | - John Hagen
- Department of General Surgery, University of Toronto, Toronto, Canada; Humber River Regional Hospital, Toronto, Canada
| |
Collapse
|
|
30
|
Ribeiro-Parenti L, De Courville G, Daikha A, Arapis K, Chosidow D, Marmuse JP. Classification, surgical management and outcomes of patients with gastrogastric fistula after Roux-En-Y gastric bypass. Surg Obes Relat Dis 2017; 13:243-248. [DOI: 10.1016/j.soard.2016.09.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 09/14/2016] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
|
|
31
|
Classification scheme for operative intervention for gastrogastric fistulae. Surg Obes Relat Dis 2016; 13:249. [PMID: 28011118 DOI: 10.1016/j.soard.2016.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 10/20/2016] [Indexed: 11/21/2022]
|
|
32
|
Takeshita N, Ho KY. Endoscopic Closure for Full-Thickness Gastrointestinal Defects: Available Applications and Emerging Innovations. Clin Endosc 2016; 49:438-443. [PMID: 27571898 PMCID: PMC5066403 DOI: 10.5946/ce.2016.104] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 07/29/2016] [Accepted: 08/02/2016] [Indexed: 12/16/2022] Open
Abstract
Full-thickness gastrointestinal defects such as perforation, anastomotic leak, and fistula are severe conditions caused by various types of pathologies. They are more likely to require intensive care and a long hospital stay and have high rates of morbidity and mortality. After intentional full-thickness opening of hollow organs for natural orifice transluminal endoscopic surgery, safe and secure closure is urgently required. The currently available advanced endoscopic closing techniques have a major role in the treatment of full-thickness gastrointestinal defects. Appropriate usage of these techniques requires taking into account their advantages and limitations during practical application. We reviewed the available endoscopic modalities, including endoscopic clips, stents, vacuum-assisted closure, gap filling, and suturing devices, discussed their advantages and limitations when treating full-thickness gastrointestinal defects, and explored emerging innovations, including a novel endoluminal surgical platform for versatile suturing and a cell-laden scaffold for effective gap filling. Although these emerging technologies still require further pre-clinical and clinical trials to assess their feasibility and efficacy, the available modalities may be replaced and refined by these new techniques in the near future.
Collapse
Affiliation(s)
| | - Khek Yu Ho
- Department of Medicine, National University of Singapore, Singapore
| |
Collapse
|
|
33
|
Niland B, Brock A. Over-the-scope clip for endoscopic closure of gastrogastric fistulae. Surg Obes Relat Dis 2016; 13:15-20. [PMID: 27693362 DOI: 10.1016/j.soard.2016.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 06/02/2016] [Accepted: 08/02/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Gastrogastric fistulae (GGF) are a well-known complication of Roux-en-Y gastric bypass (RYGB). Endoscopic approaches for closure of GGF have gained popularity, but with limited data and efficacy. OBJECTIVES The primary arm of the study was to evaluate the safety and efficacy of the endoscopic closure of GGF using the over-the-scope clip (OTSC) device. SETTING University hospital, United States METHODS: This is a retrospective review of consecutive patients at a single academic center from September 2013 to December 2014 who underwent upper endoscopy with attempted OTSC placement for closure of GGF related to RYGB. Preprocedural, procedural, and postprocedural data were collected. Outcome measures included technical success, primary success, and long-term success. RESULTS A total of 14 patients underwent attempted GGF closure using OTSC. Twelve of the 14 patients (85.7%) had technical success. Four patients were lost to follow-up. Primary success was achieved in 5 of the 10 patients (50%) in which it was assessed, either by upper gastrointestinal series or endoscopy. One of the 5 patients who had primary success was then lost to follow-up. Of the 4 patients in whom primary success was achieved and had long-term follow up, 75% (n = 3) achieved long-term success at a mean follow-up of 6.6 months from initial OTSC placement (range, 3-9), making for a long-term success rate of 33% (3/9). There were no reported complications. CONCLUSION OTSC closure of small GGF is feasible, safe, and offers a reasonable alternative to surgical revision. Large GGF may undergo attempted endoscopic closure, acknowledging a high failure rate.
Collapse
Affiliation(s)
- Benjamin Niland
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
| | - Andrew Brock
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina
| |
Collapse
|
|
34
|
Abstract
Laparoscopic Roux-en-Y gastric bypass (RYGB) is widely applied in the treatment of morbid obesity. Health personnel meeting these patients should thus be familiar with the potential clinical consequences of the modified anatomy induced by the surgery. After a RYGB, the stomach is left in situ after the closure of the upper part of the organ. This blind-ended gastric remnant may cause complications and surgical emergencies, but also opportunities for diagnostic and therapeutic intervention. The present review focuses on complications related to the gastric remnant including bleeding and acute dilatation in the early postoperative period and later adverse events such as gastroduodenal peptic disease, tumors, gastrogastric fistulas, and late dilatation. Opportunities offered by the remnant, including minimal invasive or open access for enteral nutrition, and therapeutic and diagnostic access to the bile ducts, the duodenum, and the gastric remnant, which is challenged by the modified anatomy, are discussed. Reversal of the gastric bypass and gastrointestinal reconstruction after esophageal resection have been commented on. The review aims to improve the awareness of issues related to the gastric remnant for physicians involved in the treatment and the follow-up of patients after a RYGB.
Collapse
|
|
35
|
Eisendrath P, Deviere J. Major complications of bariatric surgery: endoscopy as first-line treatment. Nat Rev Gastroenterol Hepatol 2015; 12:701-10. [PMID: 26347162 DOI: 10.1038/nrgastro.2015.151] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Leaks are the most frequent early postoperative complication in the two most popular bariatric procedures, Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy. Multimodal therapy based on self-expandable stent insertion 'to cover' the defect is the most widely documented technique to date with a reported success rate >80%. Additional experimental techniques 'to close' the defect or 'to drain' the paradigestive cavity have been reported with encouraging results. The role of endoscopy in early postoperative bleeding is limited to management of bleeds arising from fresh sutures and the diagnosis of chronic sources of bleeding such as marginal ulcer after RYGB. Post-RYGB stricture is a more delayed complication than leaks and the role of endoscopic dilation as a first-line treatment in this indication is well documented. Ring and band placement are outdated procedures for obesity treatment, but might still be an indication for endoscopic removal, a technique which does not compromise further surgery, if needed.
Collapse
Affiliation(s)
- Pierre Eisendrath
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, B-1070, Brussels, Belgium
| | - Jacques Deviere
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, B-1070, Brussels, Belgium
| |
Collapse
|
|
36
|
Abstract
Gastrointestinal leaks and fistulae are common postoperative complications, whereas intestinal perforation more commonly complicates advanced endoscopic procedures. Although these complications have classically been managed surgically, there exists an ever-expanding role for endoscopic therapy and the involvement of advanced endoscopists as part of a multidisciplinary team including surgeons and interventional radiologists. This review will serve to highlight the innovative endoscopic interventions that provide an expanding range of viable endoscopic approaches to the management and therapy of gastrointestinal perforation, leaks, and fistulae.
Collapse
|
|
37
|
Winder JS, Kulaylat AN, Schubart JR, Hal HM, Pauli EM. Management of non-acute gastrointestinal defects using the over-the-scope clips (OTSCs): a retrospective single-institution experience. Surg Endosc 2015; 30:2251-8. [PMID: 26416380 DOI: 10.1007/s00464-015-4500-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 08/03/2015] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Advanced endoscopic techniques provide novel therapies for complications historically treated with surgical interventions. Over-the-scope clips (OTSCs) have recently been shown to be effective at endoscopic closure of gastrointestinal (GI) defects. We hypothesize that by following classic surgical principles of fistula management, a high rate of long-term success can be achieved with endoscopic closure of non-acute GI tract defects. METHODS A retrospective review of a single-institution prospectively maintained database (2012-2015) of all patients referred for the management of GI leaks or fistulae who underwent attempted closure with the OTSC system (Ovesco, Germany) was performed. Acute perforations were excluded. The primary endpoint was long-term success defined by the absence of radiographic or clinical evidence of leak or fistula during follow-up. Patients were stratified by success or failure of OTSC closure and compared with Fisher's exact and Mann-Whitney U tests. RESULTS We identified 22 patients with 28 defects (22 fistulae and 6 leaks). Most patients were female (59 %) with a mean age of 54 years (±14), median BMI of 29, and prior bariatric procedure (55 %). Comorbidities included smoking history (68 %) and diabetes (23 %). The majority of defects were solitary (64 %), involved the upper GI tract (82 %), and had been present for >30 days (50 %). Multiple therapeutic interventions were necessary in 46 % of defects. There were no adverse outcomes related to OTSC placement or misfiring. Endoscopic adjuncts were used in 61 % of cases. Overall success rate was 82 % (100 % for leaks and 76 % for fistulae) at a median follow-up of 4.7 months (IQR 2.1-8.4 months). Predictors of success and failure could not be distinguished due to limited sample size. CONCLUSIONS Over-the-scope clips can be safely and effectively used in patients presenting with GI leaks and fistulae. Further research is required to characterize the determinants of long-term success and risk factors for failure.
Collapse
Affiliation(s)
- Joshua S Winder
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Afif N Kulaylat
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Jane R Schubart
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Hassan M Hal
- Department of Radiology, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Eric M Pauli
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
| |
Collapse
|
|
38
|
Winder JS, Pauli EM. Comprehensive management of full-thickness luminal defects: The next frontier of gastrointestinal endoscopy. World J Gastrointest Endosc 2015; 7:758-68. [PMID: 26191340 PMCID: PMC4501966 DOI: 10.4253/wjge.v7.i8.758] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/26/2015] [Accepted: 05/05/2015] [Indexed: 02/06/2023] Open
Abstract
Full thickness gastrointestinal defects such as perforations, leaks, and fistulae are a relatively common result of many of the endoscopic and surgical procedures performed in modern health care. As the number of these procedures increases, so too will the number of resultant defects. Historically, these were all treated by open surgical means with the associated morbidity and mortality. With the recent advent of advanced endoscopic techniques, these defects can be treated definitively while avoiding an open surgical procedure. Here we explore the various techniques and tools that are currently available for the treatment of gastrointestinal defects including through the scope clips, endoscopic suturing devices, over the scope clips, sealants, endoluminal stents, endoscopic suction devices, and fistula plugs. As fistulae represent the most recalcitrant of defects, we focus this editorial on a multimodal approach of treatment. This includes optimization of nutrition, treatment of infection, ablation of tracts, removal of foreign bodies, and treatment of distal obstructions. We believe that by addressing all of these factors at the time of attempted closure, the patient is optimized and has the best chance at long-term closure. However, even with all of these factors addressed, failure does occur and in those cases, endoscopic therapies may still play a role in that they allow the patient to avoid a definitive surgical therapy for a time while nutrition is optimized, and infections are addressed.
Collapse
|
|
39
|
Kedia P, Sharaiha RZ, Kahaleh M. Reply: To PMID 24975458. Gastroenterology 2015; 148:859. [PMID: 25726744 DOI: 10.1053/j.gastro.2015.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Prashant Kedia
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York
| | - Michel Kahaleh
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York
| |
Collapse
|