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Cone-beam computerized tomography fluoroscopy-guided percutaneous drainage for the treatment of leakage after laparoscopic sleeve gastrectomy

Year 2024, Volume: 29 Issue: 1, 29 - 36, 27.01.2024
https://doi.org/10.21673/anadoluklin.1298036

Abstract

Aim: This study aimed to review the technical and clinical results of cone-beam computed tomography (CBCT) fluoroscopy-guided drainage of anastomosis or staple line leakage, which is the most important complication after laparoscopic sleeve gastrectomy due to obesity.

Methods: A retrospective analysis was performed of the demographic findings, clinical manifestations, leakage location, and medical data of 30 cases who underwent CBCT fluoroscopy-guided percutaneous drainage due to anastomosis or staple line leakage after sleeve gastrectomy due to obesity in the interventional unit of our hospital between February 2015 and September 2020.

Results: A total of 48 drainage catheters were inserted in 30 patients (8 females and 22 males), aged 19–71 years (mean 51.24), under the guidance of CBCT fluoroscopy. Drainage was completed in a single session with one catheter in 13 (43.3%) patients. In 17 (56.7%) patients, the procedure was completed with two or more catheterizations in more than one session due to different leakage locations and subsequent occlusion or dislocation of the catheter. Inflammatory parameters and symptoms related to leakage regressed in 29 (94%) patients within 48–72 hours with clinical improvement. The success rate of percutaneous drainage was 100% without any complications.

Conclusion: Anastomosis, or staple line leakage, is one of the most serious life-threatening complications that can be seen following laparoscopic sleeve gastrectomy. CBCT fluoroscopy-guided drainage is a safe, highly effective, and minimally invasive treatment option that has a low risk of complications. This technique can facilitate the treatment of postoperative collections with alternative treatment methods.

Supporting Institution

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors

Thanks

Dear Editor, We would like to submit our enclosed manuscript entitled “Cone-Beam CT Fluoroscopy-Guided Percutaneous Drainage for the Treatment of Leakage After Laparoscopic Sleeve Gastrectomy” to publish in Anatolian Clinic the Journal of Medical Science. Thank you very much for your interest and we are looking forward to hearing from you very soon. Sincerely yours,

References

  • Frühbeck G. Bariatric and metabolic surgery: a shift in eligibility and success criteria. Nat Rev Endocrinol. 2015;11(8):465-77.
  • Baltacı D. Ünalacak M. Birinci basamakta obezite tedavisi. Turkiye Klinikleri J Fam Med-Special Topics. 2015;6(3):96-102.
  • Jamal MH, Aminian A. Bariatric surgery: Is it a safe treatment modality? Kuwait Med J. 2015;47(3):193-200.
  • Ruban A, Stoenchev K, Ashrafian H, Teare J. Current treatments for obesity. Clin Med (Lond). 2019;19(3):205-12.
  • Suraweera D, Saab EG, Choi G, Saab S. Bariatric Surgery and Liver Transplantation. Gastroenterol Hepatol (N Y). 2017;13(3):170-5.
  • Winfield RD, Reese S, Bochicchio K, Mazuski JE, Bochicchio GV. Obesity and the Risk for Surgical Site Infection in Abdominal Surgery. Am Surg. 2016;82(4):331-6.
  • Tjeertes EK, Hoeks SE, Beks SB, Valentijn TM, Hoofwijk AG, Stolker RJ. Obesity--a risk factor for postoperative complications in general surgery?. BMC Anesthesiol. 2015;15:112.
  • Slim R, Smayra T, Chakhtoura G, Noun R. Endoscopic stenting of gastric staple line leak following sleeve gastrectomy. Obes Surg. 2013;23(11):1942-5.
  • Simon F, Siciliano I, Gillet A, Castel B, Coffin B, Msika S. Gastric leak after laparoscopic sleeve gastrectomy: early covered self-expandable stent reduces healing time. Obes Surg. 2013;23(5):687-2.
  • Shehab HM, Hakky SM, Gawdat KA. An Endoscopic Strategy Combining Mega Stents and Over-The-Scope Clips for the Management of Post-Bariatric Surgery Leaks and Fistulas (with video). Obes Surg. 2016;26(5):941-8.
  • Sakran N, Goitein D, Raziel A, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2013;27(1):240-5.
  • Casella G, Soricelli E, Rizzello M, et al. Nonsurgical treatment of staple line leaks after laparoscopic sleeve gastrectomy. Obes Surg. 2009;19(7):821-6.
  • Soufron J. Leak or Fistula After Sleeve Gastrectomy: Treatment with Pigtail Drain by the Rendezvous Technique. Obes Surg. 2015;25(10):1979-80.
  • Gnannt R, Fischer MA, Baechler T, et al. Distinguishing infected from noninfected abdominal fluid collections after surgery: an imaging, clinical, and laboratory-based scoring system. Invest Radiol. 2015;50(1):17-23.
  • Haslam DW, James WP. Obesity. Lancet. 2005;366(9492):1197-209.
  • Erol V, Öztürkeri ÖA, Yılmaz TH, Emre S, Gülay H. Management of peripheric neuropathy following laparoscopic sleeve gastrectomy. J Surg Arts. 2016;9(1):35-9.
  • Hamoui N, Anthone GJ, Kaufman HS, Crookes PF. Sleeve gastrectomy in the high-risk patient. Obes Surg. 2006;16(11):1445-9.
  • Braghetto I, Korn O, Valladares H, et al. Laparoscopic sleeve gastrectomy: surgical technique, indications and clinical results. Obes Surg. 2007;17(11):1442-50.
  • Roa PE, Kaidar-Person O, Pinto D, Cho M, Szomstein S, Rosenthal RJ. Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short-term outcome. Obes Surg. 2006;16(10):1323-6.
  • Jacobs M, Bisland W, Gomez E, et al. Laparoscopic sleeve gastrectomy: a retrospective review of 1- and 2-year results. Surg Endosc. 2010;24(4):781-5.
  • Souto-Rodríguez R, Alvarez-Sánchez MV. Endoluminal solutions to bariatric surgery complications: A review with a focus on technical aspects and results. World J Gastrointest Endosc. 2017;9(3):105-26.
  • Abbas M, Cumella L, Zhang Y, et al. Outcomes of Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass in Patients Older than 60. Obes Surg. 2015;25(12):2251-6.
  • Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;21 Suppl 1(0 1):1-27.
  • Orth RC, Wallace MJ, Kuo MD; Technology Assessment Committee of the Society of Interventional Radiology. C-arm cone-beam CT: general principles and technical considerations for use in interventional radiology. J Vasc Interv Radiol. 2008;19(6):814-20.
  • Racadio JM, Babic D, Homan R, et al. Live 3D guidance in the interventional radiology suite. AJR Am J Roentgenol. 2007;189(6):357-64.
  • Wallace MJ, Kuo MD, Glaiberman C, et al. Three-dimensional C-arm cone-beam CT: applications in the interventional suite. J Vasc Interv Radiol. 2009;20(7 Suppl):523-37.
  • Fiore F, Somma F, D’Angelo R, Tarotto L, Stoia V. Cone beam computed tomography (CBCT) guidance is helpful in reducing dose exposure to pediatric patients undergoing radiofrequency ablation of osteoid osteoma. Radiol Med. 2022;127(2):183-90.
  • Schwarz J, Strobl FF, Paprottka PM, et al. CT Fluoroscopy-Guided Drain Placement to Treat Infected Gastric Leakage after Sleeve Gastrectomy: Technical and Clinical Outcome of 31 Procedures. Rofo. 2020;192(2):163-70.
  • Corona M, Zini C, Allegritti M, et al. Minimally invasive treatment of gastric leak after sleeve gastrectomy. Radiol Med. 2013;118(6):962-70.
  • Kelogrigoris M, Sotiropoulou E, Stathopoulos K, Georgiadou V, Philippousis P, Thanos L. CT-guided percutaneous drainage of infected collections due to gastric leak after sleeve gastrectomy for morbid obesity: initial experience. Cardiovasc Intervent Radiol. 2011;34(3):585-9.
  • Aberle D, Charles H, Hodak S, O’Neill D, Oklu R, Deipolyi AR. Optimizing care for the obese patient in interventional radiology. Diagn Interv Radiol. 2017;23(2):156-62.
  • Riaz RM, Myers DT, Williams TR. Multidetector CT imaging of bariatric surgical complications: a pictorial review. Abdom Radiol (NY). 2016;41(1):174-88.
  • Wallace MJ, Chin KW, Fletcher TB, et al. Quality improvement guidelines for percutaneous drainage/aspiration of abscess and fluid collections. J Vasc Interv Radiol. 2010;21(4):431-5.

Laparoskopik sleeve gastrektomi sonrası kaçak tedavisinde konik ışınlı bilgisayarlı tomografi floroskopi kılavuzluğunda perkütan drenaj

Year 2024, Volume: 29 Issue: 1, 29 - 36, 27.01.2024
https://doi.org/10.21673/anadoluklin.1298036

Abstract

Amaç: Bu çalışmanın amacı, obeziteye bağlı laparoskopik sleeve gastrektomi sonrası en önemli komplikasyon olan Konik Işınlı Bilgisayarlı Tomografi (KIBT) floroskopi kılavuzluğunda anastomoz veya stapler hattı kaçağı drenajının teknik ve klinik sonuçlarını gözden geçirmektir.

Yöntemler: Hastanemiz girişimsel radyoloji ünitesinde Şubat 2015 ve Eylül 2020 yılları arasında obezite nedeniyle sleeve gastrektomi sonrası anastomoz veya stapler hattı kaçağı nedeniyle KIBT floroskopi kılavuzluğunda perkütan drenaj uygulanan 30 olgunun demografik bulguları, klinik bulguları, kaçak yeri ve tıbbi verilerinin retrospektif olarak analizi yapıldı.

Bulgular: Yaşları 19-71 (ortalama 51.24) olan 30 hastaya (8 kadın, 22 erkek) KIBT floroskopi eşliğinde toplam 48 drenaj kateteri yerleştirildi. 13 (%43.3) hastada tek kateter ile tek seansta drenaj tamamlandı. 17 (%56.7) hastada ise farklı kaçak yerleri ve sonrasında kateterin tıkanması veya yerinden çıkması nedeniyle iki veya daha fazla kateterizasyon birden fazla seansta uygulanarak işlem tamamlandı. Enflamatuvar parametreler ve sızıntıya bağlı semptomlar 48-72 saat içinde 29 (%94) hastada klinik düzelme ile geriledi. Perkütan drenaj uygulamasının başarı oranı herhangi bir komplikasyon olmaksızın %100 idi.

Sonuç: Anastomoz veya stapler hattı kaçağı, laparoskopik sleeve gastrektomi sonrası görülebilen hayatı tehdit eden en ciddi komplikasyonlardan biridir. KIBT floroskopi kılavuzluğunda drenaj, düşük komplikasyon riski ile minimal invaziv, güvenli ve oldukça etkili bir tedavi seçeneğidir. Bu teknik, alternatif tedavi yöntemleri ile postoperatif koleksiyonların tedavisini kolaylaştırabilir.

References

  • Frühbeck G. Bariatric and metabolic surgery: a shift in eligibility and success criteria. Nat Rev Endocrinol. 2015;11(8):465-77.
  • Baltacı D. Ünalacak M. Birinci basamakta obezite tedavisi. Turkiye Klinikleri J Fam Med-Special Topics. 2015;6(3):96-102.
  • Jamal MH, Aminian A. Bariatric surgery: Is it a safe treatment modality? Kuwait Med J. 2015;47(3):193-200.
  • Ruban A, Stoenchev K, Ashrafian H, Teare J. Current treatments for obesity. Clin Med (Lond). 2019;19(3):205-12.
  • Suraweera D, Saab EG, Choi G, Saab S. Bariatric Surgery and Liver Transplantation. Gastroenterol Hepatol (N Y). 2017;13(3):170-5.
  • Winfield RD, Reese S, Bochicchio K, Mazuski JE, Bochicchio GV. Obesity and the Risk for Surgical Site Infection in Abdominal Surgery. Am Surg. 2016;82(4):331-6.
  • Tjeertes EK, Hoeks SE, Beks SB, Valentijn TM, Hoofwijk AG, Stolker RJ. Obesity--a risk factor for postoperative complications in general surgery?. BMC Anesthesiol. 2015;15:112.
  • Slim R, Smayra T, Chakhtoura G, Noun R. Endoscopic stenting of gastric staple line leak following sleeve gastrectomy. Obes Surg. 2013;23(11):1942-5.
  • Simon F, Siciliano I, Gillet A, Castel B, Coffin B, Msika S. Gastric leak after laparoscopic sleeve gastrectomy: early covered self-expandable stent reduces healing time. Obes Surg. 2013;23(5):687-2.
  • Shehab HM, Hakky SM, Gawdat KA. An Endoscopic Strategy Combining Mega Stents and Over-The-Scope Clips for the Management of Post-Bariatric Surgery Leaks and Fistulas (with video). Obes Surg. 2016;26(5):941-8.
  • Sakran N, Goitein D, Raziel A, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2013;27(1):240-5.
  • Casella G, Soricelli E, Rizzello M, et al. Nonsurgical treatment of staple line leaks after laparoscopic sleeve gastrectomy. Obes Surg. 2009;19(7):821-6.
  • Soufron J. Leak or Fistula After Sleeve Gastrectomy: Treatment with Pigtail Drain by the Rendezvous Technique. Obes Surg. 2015;25(10):1979-80.
  • Gnannt R, Fischer MA, Baechler T, et al. Distinguishing infected from noninfected abdominal fluid collections after surgery: an imaging, clinical, and laboratory-based scoring system. Invest Radiol. 2015;50(1):17-23.
  • Haslam DW, James WP. Obesity. Lancet. 2005;366(9492):1197-209.
  • Erol V, Öztürkeri ÖA, Yılmaz TH, Emre S, Gülay H. Management of peripheric neuropathy following laparoscopic sleeve gastrectomy. J Surg Arts. 2016;9(1):35-9.
  • Hamoui N, Anthone GJ, Kaufman HS, Crookes PF. Sleeve gastrectomy in the high-risk patient. Obes Surg. 2006;16(11):1445-9.
  • Braghetto I, Korn O, Valladares H, et al. Laparoscopic sleeve gastrectomy: surgical technique, indications and clinical results. Obes Surg. 2007;17(11):1442-50.
  • Roa PE, Kaidar-Person O, Pinto D, Cho M, Szomstein S, Rosenthal RJ. Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short-term outcome. Obes Surg. 2006;16(10):1323-6.
  • Jacobs M, Bisland W, Gomez E, et al. Laparoscopic sleeve gastrectomy: a retrospective review of 1- and 2-year results. Surg Endosc. 2010;24(4):781-5.
  • Souto-Rodríguez R, Alvarez-Sánchez MV. Endoluminal solutions to bariatric surgery complications: A review with a focus on technical aspects and results. World J Gastrointest Endosc. 2017;9(3):105-26.
  • Abbas M, Cumella L, Zhang Y, et al. Outcomes of Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass in Patients Older than 60. Obes Surg. 2015;25(12):2251-6.
  • Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;21 Suppl 1(0 1):1-27.
  • Orth RC, Wallace MJ, Kuo MD; Technology Assessment Committee of the Society of Interventional Radiology. C-arm cone-beam CT: general principles and technical considerations for use in interventional radiology. J Vasc Interv Radiol. 2008;19(6):814-20.
  • Racadio JM, Babic D, Homan R, et al. Live 3D guidance in the interventional radiology suite. AJR Am J Roentgenol. 2007;189(6):357-64.
  • Wallace MJ, Kuo MD, Glaiberman C, et al. Three-dimensional C-arm cone-beam CT: applications in the interventional suite. J Vasc Interv Radiol. 2009;20(7 Suppl):523-37.
  • Fiore F, Somma F, D’Angelo R, Tarotto L, Stoia V. Cone beam computed tomography (CBCT) guidance is helpful in reducing dose exposure to pediatric patients undergoing radiofrequency ablation of osteoid osteoma. Radiol Med. 2022;127(2):183-90.
  • Schwarz J, Strobl FF, Paprottka PM, et al. CT Fluoroscopy-Guided Drain Placement to Treat Infected Gastric Leakage after Sleeve Gastrectomy: Technical and Clinical Outcome of 31 Procedures. Rofo. 2020;192(2):163-70.
  • Corona M, Zini C, Allegritti M, et al. Minimally invasive treatment of gastric leak after sleeve gastrectomy. Radiol Med. 2013;118(6):962-70.
  • Kelogrigoris M, Sotiropoulou E, Stathopoulos K, Georgiadou V, Philippousis P, Thanos L. CT-guided percutaneous drainage of infected collections due to gastric leak after sleeve gastrectomy for morbid obesity: initial experience. Cardiovasc Intervent Radiol. 2011;34(3):585-9.
  • Aberle D, Charles H, Hodak S, O’Neill D, Oklu R, Deipolyi AR. Optimizing care for the obese patient in interventional radiology. Diagn Interv Radiol. 2017;23(2):156-62.
  • Riaz RM, Myers DT, Williams TR. Multidetector CT imaging of bariatric surgical complications: a pictorial review. Abdom Radiol (NY). 2016;41(1):174-88.
  • Wallace MJ, Chin KW, Fletcher TB, et al. Quality improvement guidelines for percutaneous drainage/aspiration of abscess and fluid collections. J Vasc Interv Radiol. 2010;21(4):431-5.
There are 33 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section ORIGINAL ARTICLE
Authors

Mustafa Orhan Nalbant 0000-0002-5277-9111

Çağlayan Çakır 0000-0001-8030-6795

Publication Date January 27, 2024
Acceptance Date September 3, 2023
Published in Issue Year 2024 Volume: 29 Issue: 1

Cite

Vancouver Nalbant MO, Çakır Ç. Cone-beam computerized tomography fluoroscopy-guided percutaneous drainage for the treatment of leakage after laparoscopic sleeve gastrectomy. Anatolian Clin. 2024;29(1):29-36.

13151 This Journal licensed under a CC BY-NC (Creative Commons Attribution-NonCommercial 4.0) International License.