Bariatric Times - Supplement A - Covidien - (Page 21)

THE 2007 INTERNATIONAL CONSENSUS SUMMIT ON SLEEVE GASTRECTOMY Laparoscopic Revisions of Sleeve Gastrectomy by RAUL J. ROSENTHAL, MD, FACS AUTHOR AFFILIATIONS: Dr. Rosenthal is Medical Director of the Bariatric Institute and Section Head of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, Florida. ADDRESS CORRESPONDENCE TO: Raul J. Rosenthal, MD, FACS, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, Florida 33331; Phone: (954) 659-5228; E-mail: rosentr@ccf.org BACKGROUND The increasing implementation of sleeve gastrectomy as a final or staged treatment option for morbid obesity has resulted in a new group of patients with the potential for revisional surgery. Revisions of sleeve gastrectomy can result from acute complications, such as bleeding or leaks, and chronic complications, such as strictures or missed hiatal hernias, resulting in severe gastroesophageal reflux and pain. We must also distinguish two groups of complications, resulting when sleeve gastrectomy is used as a primary procedure or when sleeve gastrectomy is used as a secondary procedure or revisional approach to replace another failed bariatric surgery (Table 1). A different group of revisions of sleeve gastrectomy are those resulting from failure of weight loss, weight regain, and those that are planned conversions to malabsorptive procedures, such as gastric bypass or biliopancreatic diversion with duodenal switch. To our knowledge, there are no literature reports of revisional surgery for failed sleeve gastrectomy implemented as a final approach for morbid obesity. There are several publications, however, reporting the results of conversion of sleeve gastrectomy to malabsorptive procedures. DISCUSSION Complications of sleeve gastrectomy are few, this being one of the most appealing characteristics of this procedure. In a review of 149 sleeve gastrectomies performed as a single-stage approach for the treatment of morbid obesity, our group reported an overall morbidity of 2.9 percent. One patient had a staple-line disruption resulting in an abscess that required percutaneous drainage; one patient had a bleeding episode from a retractor liver injury requiring laparoscopic drainage; one patient had a bowel injury during access requiring conversion to an open procedure; and one patient developed a stricture requiring endoscopic dilatation. Long-term complications of sleeve gastrectomy in this report were related only to the development of choledocholithiasis. There was no mortality in this series. When used as a revisional approach for failed gastric banding, the incidence of complications of sleeve gastrectomy is markedly increased. In the same publication, our group reported 14 patients that underwent conversion of adjustable gastric banding to sleeve gastrectomy with an overall morbidity of seven percent. One patient developed staple-line disruption followed by formation of an abscess, requiring laparoscopic revision and drainage. There was [JUNE 2008, SUPPLEMENT A] Bariatric Times 21

Table of Contents Feed for the Digital Edition of Bariatric Times - Supplement A - Covidien

Bariatric Times - Supplement A - Covidien Contents Laparoscopic Sleeve Gastrectomy: From Magenstrasse And Mill To Sleeve Sleeve Gastrectomy Provides Resoultion of Type-2 Diabetes Without Duodenal Exclusion The Relationship Bewtween The Resected Remnant And Weight Loss Laparoscopic Sleeve Gastrectomy: Results After Two And Five Years Laparoscopic Sleeve Gastrectomy As An Initial Weight Loss Procedure For High-Risk Patients With Morbid Obesity Three-Year Results Of Laparoscopic Sleeve Gastrectomy In The Treatment Of Morbid Obesity In Korea Laparoscopic Sleeve Gastrectomy: Nutritional Concerns And PostOperative Dietary Care Laparoscopic Sleeve Gastrectomy: Prevention And Treatment Of Bleeding Prevention And Treatment Of Gerd/Hiatal Hernia And Stenosis Associated With Sleeve Gastrectomy Laparoscopic Revisions Of Sleeve Gastrectomy Survey Results

Bariatric Times - Supplement A - Covidien

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