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SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY: THE EXPERIENCE OF A REFERRAL CENTER. Dr. W. JAMAL , DES, DESC Department of General Surgery King Abdulaziz University Hospital - Jeddah. - PowerPoint PPT Presentation
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SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE
GASTRECTOMY: THE EXPERIENCE OF A REFERRAL CENTER.
Dr. W. JAMAL, DES, DESC
Department of General Surgery
King Abdulaziz University Hospital - Jeddah
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE
GASTRECTOMY: THE EXPERIENCE OF A REFERRAL CENTER.
Dr. W. JAMAL,
Prof. JM. CHEVALLIER
Department of General & Digestive Surgery,
HOPITAL EUROPEEN GEORGES POMPIDOU, APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
Sleeve Gastrectomy And Bariatric Surgery
Popularity
Indications
Efficacity
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
Sleeve Gastrectomy- Restrictive Procedure- Frequency- Effective weight loss- Resolution of co-morbidity
- Part Of BPD-DS- 1st Step in super-super obese (BMI > 60)- Stand alone
Effective
<
Difficult
<
- 13 Patients Transfered to HEGP after Sleeve
- M = 1, F = 12
- Age 45.5 ( 35 – 60 ans)
- 3/13 SG (BPD-DS)
- 10/13 Sleeve (stand-alone)
- 5 after failed Band
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
Mrs. (1)
- 54 y.o- Failed Band- Sleeve Gastrectomy + BPD-DS- Gastric leak- Transferred to HEGP- Imaging: Lt. Oeso – Pleural Fistula + Abces- OR: Lavage + Drainage + J Feeding- Thoracic Drainage
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
- Decrease in Drainage- Resume Oral Intake- Discharged Home with Abdominal Drainage
- Readdmition; Respiratory Distress and Pneumopathy (Recurrence Oeso-Pleural Fistula)- Antibiotic + Gastric Stent
Mme (1)
- Recurrence Oeso-Pleural Fistula
OR: Total GastectomyHOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
Mrs. (2)
- 57 y.o
- Gastric Band 1999, Removal of Band 2002
- Sleeve G + BPD-DS on 16/11/2005
- Gastric Leak at D11
- OR: Well managed, Well tolerated
- D18 upper GI Hg, OGD
- D34 (Hemorragic Choc), Transfusion 12 PRBC
- CT-Scan: Rupture of PseudoAnurism of SA
- Transfered to HEGP
- Embolisation
- Dischared 1m HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
Mrs. (3)
- 43 y.o
- Sleeve G 21 sept 2010
- D2 Gastric Leak + Lt. sub-phrenic Abces
- OR: Drainage + J Feeding +Antibiotic
- Transferred to HEGP
- Sepsis (Pneumopathy)
- Failure Gastric Stent X 2
- Clip OVESCO 15/12/2010
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
Mrs (4)
- 60 y.o
- Sleeve G 22/7/2010
- D3 Respiratory Distress
- Barium Meal: NO Leak
- CT-Scan: Perisplenic Fluid Collection
- Antibiotic + Transferred to HEGP
- CT-Scan2: Gastric Leak + Lt. Sub-Phrenic Collection + Lt. Pleural
Effusion
-OR: Intubation of Leakage Site by T-tube Drain + Drainage + J Feeding
- Resume Oral Intake + Removal Of T-tube on October 2010
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
Mrs (5)
- 30 y.o- Sleeve Gastrectomy- Post-Op OK, BUT……- Progressive Food Intake Intolerance - 3 OGD Unremarkable- Barium Meal ……..
TWIST
What to do ??
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
Mrs (6)
- 35 y.o - Failure Gastric Band Placement in 2008- 21/10/2010 Failure Band ---} Sleeve- Stabling Calibration tube + important Hg- Conversion to Laparotomie, Anastomose Oeso-J- Methylen Blue Test Positive- ICU, Extubation at D1, fever 40, WBC 20000- CT-Scan D2, 2 Leaks- Transferred to HEGP- OR: Intubation of Leakage site (Spirale)- Resume Oral Intake on March 2011
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
DIAGNOSTIQUE N= Tx
- PseudoAnurism 1 Embolisation- Gastro-Cutaneous Fistula 2 Clips- Oeso-Gastric Leaks 5 3Drainage,1Clip, 1TG- Calibration tube Stapling 1 TG- Gastropleural Fistula 1 TG- Abces 2 Drainage- Twist 1 Stent
Mean Length of Hospital Stay = 60 Jours ( 13, 135)
Mean Number of Admission = 1.9 Hospi (1, 4)
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
CONCLUSION:
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
Sleeve Gastrectomy is an effective weight loss procedure, despite its complications which are rare, it could be serious and considerably extend the legnth of hospital stay, with important fonctional and psychological consequences on patients.
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
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