Perioperative hemorrhagic complications after laparoscopic sleeve gastrectomy: four-year experience of a bariatric center of excellence

被引:35
|
作者
De Angelis, Francesco [1 ,2 ]
Abdelgawad, Mohamed [1 ,2 ,3 ]
Rizzello, Mario [1 ,2 ]
Mattia, Consalvo [4 ]
Silecchia, Gianfranco [1 ,2 ]
机构
[1] Univ Roma La Sapienza, Div Gen Surg, Via F Faggiana 1668, I-04100 Latina, Italy
[2] Univ Roma La Sapienza, Dept Med Surg Sci & Biotechnol, Bariatr Ctr Excellence, Via F Faggiana 1668, I-04100 Latina, Italy
[3] Mansoura Univ, Gastroenterol Surg Ctr GEC, Fac Med, Mansoura, Egypt
[4] Univ Roma La Sapienza, Dept Med Surg Sci & Biotechnol, Unit Anesthesia & ICU, Via F Faggiana 1668, I-04100 Latina, Italy
来源
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2017年 / 31卷 / 09期
关键词
Sleeve gastrectomy; Bleeding; Hemostasis; Hematoma; Late leak complications management; STAPLE-LINE; SURGERY;
D O I
10.1007/s00464-016-5383-y
中图分类号
R61 [外科手术学];
学科分类号
摘要
Bleeding and gastric fistula are the most common postoperative complications after laparoscopic sleeve gastrectomy (LSG). The long stapler line represents the most frequent source of bleeding, which ranges between 0 and 20%. The aim of this retrospective study was to analyze the 4-year experience of a high-volume center with respect to the prevention and management of perioperative LSG bleeding. The prospectively maintained database from June 2012 to June 2016 was reviewed. Outcomes, especially perioperative bleeding (until patient discharge), its management, and follow-ups, were analyzed. Out of 870 LSG (603 females, 267 males), 31 cases (3.5%) of postoperative complications were registered: bleeding was the most frequent complication (1.9%). Hemoperitoneum was managed laparoscopically in 9/17 patients (52.9%) with only one conversion to laparotomy (11.1%). Conservative treatment successfully controlled bleeding in 8/17 patients (47.1%). However, four patients (50%) developed an infected hematoma; two of them were treated conservatively with a CT-guided drainage, and the other two were complicated by late gastric leak treated laparoscopically. No mortalities occurred in the investigated cases. In a high-volume center, the expected incidence of bleeding after LSG is 1.7% even after the adoption of all preventive strategies. The intraoperative protocol for detecting silent bleeding was effective, and no cases of bleeding were observed since its application. Our findings showed that the conservative management of postoperative bleeding should be considered as a high-risk condition for late leakage.
引用
收藏
页码:3547 / 3551
页数:5
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