Early and Late Complications of Sleeve Gastrectomy

Mustafa Essam Amin;

Abstract


Summary and Conclusion
O
besity is a leading preventable cause of death worldwide, with increasing rates in adults and children. Authorities view it as one of the most serious public health problems of the 21st century.
Obesity is stigmatized in much of the modern world (particularly in the Western world), though it was widely seen as a symbol of wealth and fertility at other times in history and still is in some parts of the world. In 2013, the American Medical Association classified obesity as a disease
The cause of obesity is complex and multi-factorial. At the simplest level, obesity develops as a result of a period of chronic energy imbalance and is maintained by a continued elevated energy intake sufficient to maintain the acquired higher energy needs of the obese state. Complex interactions between biological (including genetic and epigenetic), behavioral, social, hormonal and environmental factors (including chronic stress) are involved in regulation of energy balance and fat stores.
The U.S. Preventive Services Task Force (USPSTF) recommends that all adults be screened for obesity. Thus, BMI should be measured and recorded at each visit, as with any other vital sign.
Obesity and its severity can be measured by several methods. They include the following:
(a) Body mass index (BMI): this is the most common method to measure obesity in adults and children.
(b) Skin fold thickness (biceps, triceps, subscapular, and suprailiac): it measures the subcutaneous fat to determine the percentage of body fat.
(c) Waist circumference: it is a common method to measure the risk of cardio metabolic affection.
(d) Waist-to-hip ratio: it examines fat distribution and it is used less frequently.
(e)Waist-to-height ratio: waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardio metabolic risk factors in both sexes.
The connection between excess body fat and health risks such as type 2 diabetes, hypertension, dyslipidemia, and coronary heart disease has been well-documented and provides the rationale for management of obesity. Significant weight loss may be ideal, even a modest reduction in weight (5% to 10% of total body weight) can have significant health benefits. Although many family physicians are pessimistic about their ability to influence patients to make necessary lifestyle changes in order to achieve weight loss, research suggests that patients are more likely to attempt weight loss when their primary care physicians recommend it
Appropriate management of obesity complications in addition to weight management may include: Nutrition: reduce energy intake by 500-1000kcal/day, Physical activity, Behavioral intervention, Prevention and treatment of co-morbidities, Pharmacotherapy, Bariatric surgery
Bariatric surgeries make tremendous improvement in obese patients’ health and life. They decrease overall obesity complications and improve the quality of life. They are indicated in patients with BMI >40 kg/m2 or >35 kg/m2 with complications associated with obesity such as hypertension, type 2 diabetes mellitus, and obstructive sleep apnea, as well as for those not improving with medical therapy. In very high-risk patients, staged approaches may be required in which one operation (either gastrectomy or intestinal bypass) is followed by the other operation in two separate surgical procedures.
Sleeve gastrectomy is an excellent procedure for the surgical management of morbid obesity. Expected weight loss at 6 and 12 months averages 49% and 56%, respectively. Improvement in co-morbidities of obesity, such as hypertension and diabetes mellitus, has been reported to occur in the majority of patients with resolution in 60-100%.
Laparoscopic sleeve gastrectomy is a new and effective procedure for the surgical management of morbid obesity. Basic understanding of common complications and available treatment options is essential. By early diagnosis and treatment of these complications, patient morbidity and mortality might be reduced.
The complications of sleeve gastrectomy can be classified into: acute (within 2 weeks of surgery) which include hemorrhage, leak, deep vein thrombosis, pulmonary embolus and abscess; and late complications which include stricture, nutrient deficiency, Gastro-oesophageal refleux disease (GERD) and gastric sleeve dilatation.
Leak is the commonest and most feared early complication, and the one most directly related to surgical technique. Leakage can occur from any suture or staple line after gastric bypass or sleeve gastrectomy or even from unrecognized perforation at the time of adjustable band insertion.
Tan et al. reported that incidence of anastomotic leak after sleeve gastrectomy ranges between 0% and 20% with most leaks appear in the proximal third of the stomach, close to the gastroesophageal junction.
The risk of postoperative bleeding has been reported to be between 1% and 6% after laparscopic sleeve gastrectomy(LSG).The source of bleeding can be intra- or extraluminal. Intraluminal bleeding from the staple line usually presents with an upper gastrointestinal bleed. extraluminal bleeding include the gastric staple line, spleen, liver or abdominal wall at the sites of trocar entry.


Other data

Title Early and Late Complications of Sleeve Gastrectomy
Other Titles المضاعفات المبكرة والمتأخرة لجراحة تكميم المعدة
Authors Mustafa Essam Amin
Issue Date 2015

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