Necrosis of the Nissen-Sleeve Gastrectomy (N-SG) Wrap
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MULTIMEDIA ARTICLE
Necrosis of the Nissen-Sleeve Gastrectomy (N-SG) Wrap El Mehdi Skalli 1 & Chetan D Parmar 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Sleeve gastrectomy (SG) is the highest performed bariatric procedure in the world. Gastro-oesophageal reflux disease (GERD) is widely debated topics after SG. Nissen-Sleeve gastrectomy (N-SG) technique was reported in 2016 as an alternative solution to this problem. They reported concern about valve ischaemia but did not report any such complication in the beginning of their experience. We would like to share video showing this complication and technique to manage it. Method Data was retrospectively analysed. Results A 45-year-old female with BMI of 35.5 kg/m had an uneventful Nissen-SG. She had GERD treated with proton pump inhibitor (PPI). The preoperative gastroscopy showed peptic oesophagitis with hiatal hernia. On post-operative day (POD) 1, the patient complained of severe abdominal pain, tachycardia and fever. Inflammatory markers were raised. Diagnostic laparoscopy showed necrosis of the wrap. The wrap was carefully undone and resected with a stapler (with seamguard). Thorough wash with saline was performed. Drain was left near the new staple line. A CT scan with oral contrast 4 days later confirmed absence of a gastric leak. The patient was discharged 8 days after the revision on PPI and antibiotics. Two-years post-operatively, the patient is doing well and her GERD symptoms are controlled with PPI. Conclusion Wrap necrosis is a life-threatening complication after N-SG. This case is shared to raise awareness of this complication. This was successfully managed by prompt laparoscopy and wrap resection. Ideally such complications should be referred to experts or centers with high volume of bariatric surgery. Keywords Sleeve Gastrectomy . Nissen-Sleeve . Wrap necrosis
Abbreviations SG Sleeve gastrectomy N-SG Nissen-Sleeve gastrectomy GERD Gastro-oesophageal reflux disease
Background Sleeve gastrectomy (SG) is now the highest performed bariatric procedure in the world [1]. Gastro oesophageal reflux disease (GERD) is the most widely debated topic after SG [1]. It Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04808-6) contains supplementary material, which is available to authorized users. * Chetan D Parmar [email protected] 1
CHU de Montpellier, Montpellier, France
2
Whittington Hospital, London, UK
is estimated that 10 to 20% patients can develop GERD after SG [1, 2]. Nissen-Sleeve gastrectomy (N-SG) technique was reported in 2016 as an alternative solution to this problem [2]. The authors showed satisfactory short-term results. They reported concern about valve ischaemia but did not have any such complication in the beginning of their experience. We would like to share this video showing complication of necrosis of N-SG wrap and the technique to manage it.
Method The data were retrospectively collected for this presentation.
Results A 45-year-old
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