Skip to main content
SpringerLink
Log in

Endoskopisches Komplikationsmanagement nach Schlauchmagenbildung

Endoscopic management of complications after laparoscopic sleeve gastrectomy

  • Leitthema
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Die Schlauchmagenbildung („sleeve gastrectomy“, SG) ist gegenwärtig weltweit das am häufigsten durchgeführte adipositaschirurgische Operationsverfahren. Die gefürchtete operationsimmanente Komplikation dabei ist eine Leckage der Klammernahtreihe, die sehr schwierig zu therapieren ist und oft persistiert. In diesem Beitrag sollen die endoskopischen Therapieoptionen bei Komplikationen nach einer Schlauchmagenbildung, insbesondere die Therapie der Schlauchmagenleckage dargestellt werden. Dabei sind das Verständnis der Pathophysiologie der auftretenden Komplikation sowie die exakte chirurgische Kenntnis des Operationsverfahrens wesentliche Voraussetzungen für die erfolgreiche Therapie. Die eigentliche endoskopische Verfahrenswahl richtet sich dann pragmatisch nach der Ausstattung und den Möglichkeiten der jeweiligen Endoskopieeinheit und den Fertigkeiten des ausführenden Endoskopikers. Aktuell scheint die interne Drainage am zielführendsten zu sein.

Abstract

Laparoscopic sleeve gastrectomy (SG) is currently the most commonly performed standalone bariatric procedure worldwide. Gastric staple line leakage is the feared immanent complication of the operation, which is difficult to treat and often persists. This article presents the endoscopic treatment options for complications after laparoscopic SG, particularly the treatment of gastric staple line leakage. Most important for a successful treatment is the understanding of the underlying pathophysiological causes, the exact surgical comprehension of the procedure and advanced endoscopic skills. The choice of endoscopic intervention depends on the available strategies as well as on the skills of the executing endoscopist. Currently, internal drainage seems to be the most expedient method.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Gagner M, Hutchinson C, Rosenthal RJ (2016) Fifth International Consensus Conference: status of sleeve gastrectomy. Surg Obes Relat Dis 12(49):750–756

    Article  PubMed  Google Scholar 

  2. Fuks D, Verhaeghe P, Brehant O et al (2009) Results of laparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity. Surgery 145:106–113

    Article  PubMed  Google Scholar 

  3. Yehoshua RD, Eidelman LA, Stein M et al (2008) Laparoscopic sleeve gastrectomy – volume and pressure assessment. Obes Surg 18(9):1083–1008

    Article  PubMed  Google Scholar 

  4. Ren CJ, Patterson E, Gagner M (2000) Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients. Obes Surg 16(6):514–523

    Article  Google Scholar 

  5. De Cespel J, Burpee S, Jossart G et al (2001) Laparoscopic biliopancreatic diversion with a duodenal switch for morbid obesity: a feasibility study in pigs. J Laparoendosc Adv Surg Tech A 11(2):79–83

    Article  Google Scholar 

  6. Baltasar A, Bou R, Miró J et al (2002) Laparoscopic biliopancreatic diversion with duodenal switch: technique and initial experience. Obes Surg 12(2):245–248

    Article  CAS  PubMed  Google Scholar 

  7. Weiner RA, Blanco-Engert R, Weiner S et al (2004) Laparoscopic biliopancreatic diversion with duodenal switch: three different duodeno-ileal anastomotic techniques and initial experience. Obes Surg 14(3):334–340

    Article  CAS  PubMed  Google Scholar 

  8. Feng JJ, Gagner M (2002) Laparoscopic biliopancreatic diversion with duodenal switch. Semin Laparosc Surg 9(2):125–129

    Article  PubMed  Google Scholar 

  9. Dapri G, Cadière GB, Himpens J (2011) Superobese and super-superobese patients: 2‑step laparoscopic duodenal switch. Surg Obes Relat Dis 7(6):703–708

    Article  PubMed  Google Scholar 

  10. Milone L, Strong V, Gagner M (2005) Laparoscopic sleeve gastrectomy is superior to endoscopic intragastric balloon as a first stage procedure for super-obese patients (BMI > or = 50). Obes Surg 15(5):612–617

    Article  PubMed  Google Scholar 

  11. Silecchia G, Boru C, Pecchia A et al (2006) Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg 16(99):1138–1144

    Article  PubMed  Google Scholar 

  12. Mongol P, Chosidow D, Marmuse JP (2005) Laparoscopic sleeve gastrectomy as an initial bariatric operation for high-risk patients: initial results in 10 patients. Obes Surg 15(7):1030–1033

    Article  Google Scholar 

  13. Batasar A, Serra C, Pérez N (2005) Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg 15(8):1124–1128

    Article  Google Scholar 

  14. Han MS, Kim WW, Oh JH (2005) Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg 15(10):1469–1475

    Article  Google Scholar 

  15. Catheline JM, Cohen R, Khochtali I et al (2006) Treatment of super super morbid obesity by sleeve gastrectomy. Presse Med 35(3):383–387

    Article  PubMed  Google Scholar 

  16. Deitel M, Crosby RD, Gagner M (2008) The First International Consensus Summit for sleeve gastrectomy (SG), New York City, October 25–27, 2007. Obes Surg 18(5):487–496

    Article  PubMed  Google Scholar 

  17. Gagner M, Deitel M, Kalberer DM et al (2009) The Second International Consensus Summit for sleeve gastrectomy, March 19–21, 2009. Surg Obes Relat Dis 5(4):476–485

    Article  PubMed  Google Scholar 

  18. Rosenthal RJ, International Sleeve Gastrectomy Expert Panel (2012) International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of > 12,000 cases. Surg Obes Relat Dis 8(1):8–19

    Article  PubMed  Google Scholar 

  19. Gagner M, Deitel M, Erickson AL et al (2013) Survey on laparoscopic sleeve gastrectomy (LSG) at the Fourth International Consensus Summit on Sleeve Gastrectomy. Obes Surg 23(12):2013–2017

    Article  PubMed  Google Scholar 

  20. Samakar K, McKenzie TJ, Tavakkoli A et al (2016) The effect of laparoscopic sleeve gastrectomy with concomitant hiatal hernia repair on gastroesophageal reflux disease in the morbidly obese. Obes Surg 26(19):61–66

    Article  PubMed  Google Scholar 

  21. Melissas J, Braghetto I, Molina JC et al (2015) Gastroesophageal reflux disease and sleeve gastrectomy. Obes Surg 25(12):2430–2435

    Article  PubMed  Google Scholar 

  22. Stenard F, Iannelli A (2015) Laparoscopic sleeve gastrectomy and gastroesophageal reflux. World J Gastroenterol 21(36):10348–10357

    Article  PubMed  PubMed Central  Google Scholar 

  23. Stroh C, Köckerling F, Lange V et al (2016) Results of more the 11,800 sleeve gastrectomies. Data analysis of the German bariatric registry. Ann Surg 263(5):949–955

    Article  PubMed  Google Scholar 

  24. Vargas EJ, Abu Dayyeh BK (2018) Keep calm under pressure: a paradigm shift in postsurgical leaks. Gastrointest Endosc 87(2):438–441

    Article  PubMed  Google Scholar 

  25. Aurora AR, Khaitan L, Saber AA (2012) Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc 26(6):1509–1515

    Article  PubMed  Google Scholar 

  26. Parikh M, Issa R, McCrillis A, Saunders JK et al (2013) Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg 257:231–237

    Article  PubMed  Google Scholar 

  27. Berry R, Miyagawa T, Paskaranandavadivel N et al (2016) Functional physiology of the human terminal antrum defined by high-resolution electrical mapping and computational modeling. Am J Physiol Gastrointest Liver Physiol 311(5):G895–G902

    Article  PubMed  PubMed Central  Google Scholar 

  28. Gomes M, Ramacciotti E, Miranda F Jr et al (2009) Vascular flow of the gastric fundus after arterial devascularization: an experimental study. J Surg Res 152:128–134

    Article  PubMed  Google Scholar 

  29. Saber AA, Azar N, Dekal M, Abdelbaki TN (2015) Computed tomographic scan mapping of gastric wall perfusion and clinical implications. Am J Surg 209:999–1006

    Article  PubMed  Google Scholar 

  30. Natoudi M, Theodorou D, Papalois A, Drymousis P, Alevizos L, Katsaragakis S et al (2014) Does tissue ischemia actually contribute to leak after sleeve gastrectomy? An experimental study. Obes Surg 24:675–683

    Article  PubMed  Google Scholar 

  31. Konca C, Yilmaz AA, Celik SU et al (2018) The effects of Bougie diameters on tissue oxygen levels after sleeve gastrectomy: a randomized experimental trial. Balkan Med J 35(3):245–249

    Article  PubMed  PubMed Central  Google Scholar 

  32. Lorenzo D, Guilbaud T, Gonzalez JM et al (2018) Endoscopic treatment of fistulas after sleeve gastrectomy: a comparison of internal drainage versus closure. Gastrointest Endosc 87:429–437

    Article  PubMed  Google Scholar 

  33. Loske G, Müller C (2009) Endoscopic vacuum-assisted closure of upper intestinal anastomotic leaks. Gastrointest Endosc 69:601–602

    Article  PubMed  Google Scholar 

  34. Schorsch T, Müller C, Loske G (2013) Endoscopic vacuum therapy of anastomotic leakage and iatrogenic perforation in the esophagus. Surg Endosc 27(6):2040–2045

    Article  PubMed  Google Scholar 

  35. Kuehn F, Loske G, Schiffmann L et al (2017) Endoscopic vacuum therapy for various defects of the upper gastrointestinal tract. Surg Endosc 31(9):3449–3458

    Article  PubMed  Google Scholar 

  36. Leeds SG, Burdick JS (2016) Management of gastric leaks after sleeve gastrectomy with endoluminal vacuum (E-Vac) therapy. Surg Obes Relat Dis 12:1278–1285

    Article  PubMed  Google Scholar 

  37. Puli SR, Spofford SS, Thompson CC (2012) Use of self-expandable stents in the treatment of bariatric surgery leaks: a systematic review and meta-analysis. Gastrointest Endosc 75(2):287–293

    Article  PubMed  Google Scholar 

  38. Garofalo F, Noreau-Nguyen M, Denis R et al (2017) Evolution of endoscopic treatment of sleeve gastrectomy leaks: from partially covered to long, fully covered stents. Surg Obes Relat Dis 13(6):925–932

    Article  PubMed  Google Scholar 

  39. Moon T, Hong D, Chun HJ et al (2001) New approach to radial expansive force measurement of self expandable esophageal metal stents. Asiao J 47(6):646–650

    Article  CAS  Google Scholar 

  40. Donatelli G, Dumont JL, Pourcher G et al (2017) Pneumatic dilation for functional helix stenosis after sleeve gastrectomy: long-term follow-up. Surg Obes Relat Dis 13(6):943–950

    Article  PubMed  Google Scholar 

  41. Parikh A, Alley JB, Perterson RM et al (2012) Management options for symptomatic stenosis after laparoscopic vertical sleeve gastrectomy in the morbidly obese. Surg Endosc 26(3):738–746

    Article  PubMed  Google Scholar 

  42. Rebibo L, Hakim S, Dhahri A et al (2016) Gastric stenosis after laparoscopic sleeve gastrectomy: diagnosis and management. Obes Surg 25(5):995–1001

    Article  Google Scholar 

  43. Jurowich C, Germer CT, Seyfried F, Thalheimer A (2012) Metabolische Chirurgie. Chirurg 83(6):583–598. https://doi.org/10.1007/s00104-011-2239-9

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Allgemein‑, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinik Würzburg, Oberdürrbacherstr. 2, 97080, Würzburg, Deutschland

    C. Stier & C. Corteville

  2. Medizinische Klinik und Poliklinik I, Universitätsklinik Würzburg, Würzburg, Deutschland

    C. Stier

Authors
  1. C. Stier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Corteville
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Stier.

Ethics declarations

Interessenkonflikt

C. Stier und C. Corteville geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stier, C., Corteville, C. Endoskopisches Komplikationsmanagement nach Schlauchmagenbildung. Chirurg 89, 969–976 (2018). https://doi.org/10.1007/s00104-018-0723-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-018-0723-1

Schlüsselwörter

Keywords

Search

Navigation