Laparoscopic Sleeve Gastrectomy: Recognizing and Treating Complications
The overall rate of serious morbidity from the laparoscopic sleeve gastrectomy (LSG) is 3.8 %, and 30-day mortality rate is 0.1 % [1]. Complications unique to LSG include staple line leaks and stricture or obstruction of the gastric lumen. The bedside nur
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Andrew Loveitt
The overall rate of serious morbidity from the laparoscopic sleeve gastrectomy (LSG) is 3.8 %, and 30-day mortality rate is 0.1 % [1]. Complications unique to LSG include staple line leaks and stricture or obstruction of the gastric lumen. The bedside nurse must also be vigilant for complications that can present in all surgical patients including bleeding, DVT/PE, and infectious processes.
18.1 Staple Line Leaks Inherent to LSG is the creation of a long staple line to form the gastric pouch. Gastric leakage from this staple line can be a life-threatening complication which occurs in 1–3 % of LSG and is the most common cause of major morbidity and mortality [2, 3]. To prevent this complication, surgeons have attempted to reinforce the staple line either through the use of a buttressing material, through application of sealants, or by oversewing. There is no consensus on the preferred technique, and this seems to have a larger effect on bleeding than leakage [4]. Leaks can be classified as mechanical (stapler misfire, direct tissue injury) which present within 2 days of surgery or ischemic which appear 5–6 days postoperatively. Late leaks have been noted up to 16 months after surgery [4]. From a nursing perspective, the most important aspect is early recognition. Most agree that tachycardia, specifically a HR >120, is the most important and constant indication of a leak. This is often accompanied by acute (early) or more chronic (late) abdominal pain and fevers. Although an elevated WBC count or CRP may be present, this is difficult to interpret in the presence of a recent surgery [4]. When a leak is suspected, CT scan with IV and PO water-soluble contrast is the best noninvasive test [3]. A. Loveitt, DO Department of General Surgery, Rowan University, Stratford, NJ, USA e-mail: [email protected] © Springer International Publishing Switzerland 2017 A. Loveitt et al. (eds.), Passing the Certified Bariatric Nurses Exam, DOI 10.1007/978-3-319-41703-5_18
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A. Loveitt
There is no consensus on the management of postoperative leaks. However, the first question that must be asked is if the patient is stable or unstable. If unstable, the answer is to return to the OR for washout and drainage. If stable, the management becomes more complicated. Typically conservative approaches are favored including IV hydration, NPO, PPIs, parenteral nutrition, percutaneous drainage, and broad-spectrum antibiotics and antifungals. If there is a persistent leak (2 weeks) despite conservative management, endoscopic therapies including clipping, application of fibrin glue, and stenting can be attempted. If all else fails, the patient will need a revisional surgery which could include conversion to a Roux-en-Y gastric bypass or even a total gastrectomy with esophageal-jejunal anastomosis [3, 4].
18.2 Bleeding Bleeding requiring transfusion occurs in 0.65 % of patients following a LSG, and bleeding from the staple line itself is thought to occur in 1–2 % of patients [1, 2]. While a relatively uncommon complicatio
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