Table 3 Complications of laparoscopic sleeve gastrectomy
Complications and radiographic findings | Management | |
|---|---|---|
Intraoperative (n = 3) | Liver contusion (n = 1) | |
Splenic tear (n = 2): a serrated low-density area in the spleen | ||
Early postoperative (n = 48) | • Leakage (n = 18): (23.1%); within 1–10 days. (Figs. 8 and 9) • The most common site of leak was the proximal 1/3 of the sleeve just below the esophagogastric junction, followed by middle then lower thirds • Pneumoperitoneum • Free fluid | Laparoscopic re-exploration and surgical closure |
Perigastric collection and hematoma (n = 26) (33%) within 3–10 days (Fig. 7) • Acute hematoma: hyperdense collection • Hemoperitoneum (n = 5) • Extravasation of IV contrast if there is active bleeding from staple lines or suture lines (n = 2) | Conservative (n = 9) laparoscopic—re-exploration and surgical drainage in the presence of hemodynamic instability (n = 3) | |
Gastropancreatic abscess (n = 1) located in the left subphrenic area (Fig. 11) | CT-guided percutaneous drainage with appropriate antibiotic coverage | |
Gastrobronchial fistula (n = 1) The site of the fistulous tract was clearly visualized by CT | failed to heal after endoscopic insertion of a stent | |
Rectus sheath hematoma: (n = 2) | ||
Late postoperative (n = 27) | Vascular thrombosis: PV, SMV, and SV (n = 10) (13%) within 6 months to 2 years postoperatively (Fig. 10) | Medical treatment. |
Gastric stricture (n = 1) (Fig. 12) | Focal strictures respond to endoscopic dilation, but longer segments of narrowing necessitate surgical revision or resection of the pouch | |
Dilatation of the gastric pouch (n = 8) (10%) and weight gain (Fig. 13) | Surgical revision of the pouch | |
Incisional hernia(n = 1): eventration of bowel loops and mesenteric fat | ||
Hiatus hernia (n = 4) | ||
Gastritis(n = 1) | ||
S.C. seroma (n = 1) | ||
Port site hernia (n = 1) |