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Sleeve Gastrectomy: Risks, Outcomes, and Complications
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Sleeve Gastrectomy: Risks, Outcomes, and Complications

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: closed (25 July 2024) | Viewed by 14126

Special Issue Editor

Prof. Dr. Shinichi Okazumi

E-Mail Website
Guest Editor
1. JCHO Chiba Hospital, 682 Nitona, Chuo-ku, Chiba 260-0801, Japan
2. Department of Surgery, Toho University Sakura Medical Center, Chiba 285-8741, Japan
Interests: digestive surgery; gastrono intestinal surgery

Special Issue Information

Dear Colleagues,

Currently, it is widely recognized that obesity leads to complications of various diseases and the shortening of survival time, and it has been also reported as a high risk factor for COVID-19 severity. Thus, obesity treatment has become a global medical issue. Among the benefits, it was found that surgical treatment for severe obesity can improve the status of various metabolic diseases in addition to the weight loss effect, which was the original purpose for its initiation in the 1950s, and it has recently been referred to as “metabolic surgery”. Currently, around 800,000 such surgeries are performed annually worldwide, and the number of sleeve gastrectomy operations is increasing. Although the surgical procedure is simple, detailed perioperative care must be taken to prevent postoperative several complications. Short-term complications include bleeding and anastomotic insufficiency, and long-term complications include gastroesophageal reflux (GERD), stenosis, and poor weight loss. Therefore, the estimation of operative indication, risk assessment, perioperative management, and follow-up management are important, and revision surgery should be required for patients with poor long-term results. In this Special Issue, we aim to analyze risk assessment, therapeutic effect, and complications in severe obesity treatment by sleeve gastrectomy to for improved outcomes.

Prof. Dr. Shinichi Okazumi
Guest Editor

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Keywords

  • sleeve gastrectomy
  • risk factor
  • GERD
  • COVID-19
  • revision surgery

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Published Papers (6 papers)

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Review

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15 pages, 1945 KiB  
Review
New Endoscopic Devices and Techniques for the Management of Post-Sleeve Gastrectomy Fistula and Gastric Band Migration
by Carlo Felix Maria Jung, Cecilia Binda, Luigi Tuccillo, Matteo Secco, Giulia Gibiino, Elisa Liverani, Chiara Petraroli, Chiara Coluccio and Carlo Fabbri
J. Clin. Med. 2024, 13(16), 4877; https://doi.org/10.3390/jcm13164877 - 18 Aug 2024
Viewed by 1768
Abstract
Post-sleeve gastrectomy fistulas are a rare but possibly severe life-threatening complication. Besides early reoperation and drainage, endoscopy is the main treatment option. According to the clinical setting, endoscopic treatment options comprise stent or clip placement. New endoscopic therapies have recently gained attention, including [...] Read more.
Post-sleeve gastrectomy fistulas are a rare but possibly severe life-threatening complication. Besides early reoperation and drainage, endoscopy is the main treatment option. According to the clinical setting, endoscopic treatment options comprise stent or clip placement. New endoscopic therapies have recently gained attention, including endoscopic vacuum therapy, VacStent therapy, endoscopic internal drainage with pigtail stents, endoscopic suturing and stem cell injection. In this narrative review, we shed light on recent literature, developments, indications and contraindications of these treatments. Intragastric gastric band migration is a rare complication after gastric band positioning. Reoperation can sometimes be difficult, especially when a gastric band has already migrated far into the stomach. Endoscopic retrieval can be a valid, non-invasive therapeutic solution. We reviewed the current literature on this matter. Full article
(This article belongs to the Special Issue Sleeve Gastrectomy: Risks, Outcomes, and Complications)
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16 pages, 2307 KiB  
Review
Rare Complications Following Laparoscopic Sleeve Gastrectomy
by Amanda Belluzzi, Jack W. Sample, Katie Marrero, Daniel Tomey, Suraj Puvvadi, Ishna Sharma and Omar M. Ghanem
J. Clin. Med. 2024, 13(15), 4456; https://doi.org/10.3390/jcm13154456 - 30 Jul 2024
Viewed by 2250
Abstract
Metabolic and bariatric surgery (MBS) is the most effective and durable therapeutic intervention for patients with obesity. In recent years, laparoscopic sleeve gastrectomy (SG) has become the most commonly performed primary MBS procedure owing to its technical feasibility and excellent short-term outcomes. Despite [...] Read more.
Metabolic and bariatric surgery (MBS) is the most effective and durable therapeutic intervention for patients with obesity. In recent years, laparoscopic sleeve gastrectomy (SG) has become the most commonly performed primary MBS procedure owing to its technical feasibility and excellent short-term outcomes. Despite these favorable results and perceived advantages, SG is associated with several unique complications. Complications such as a postoperative leak or bleeding have been more commonly observed and reported than others, and their management approaches are well described. However, other complications following SG are far less familiar to surgeons, which may delay recognition and result in poor patient outcomes. Of these complications, we describe splenic injuries; esophageal perforation; staple line malformations; stapling of intraluminal devices; phytobezoar formation; gastro-colic, gastro-pleural and gastro-bronchial fistula; pancreatic leak; and portomesenteric venous thrombosis. It is paramount for surgeons to be aware of these underreported issues and have the resources to learn how to recognize and manage them when they arise. This review aims to describe rare (i.e., reported incidence <1%) and underdescribed complications after SG, focusing on causes, clinical presentation, prevention strategies, and management. Full article
(This article belongs to the Special Issue Sleeve Gastrectomy: Risks, Outcomes, and Complications)
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20 pages, 8482 KiB  
Review
Endoscopic Management of Post-Sleeve Gastrectomy Complications
by Muaaz Masood, Donald E. Low, Shanley B. Deal and Richard A. Kozarek
J. Clin. Med. 2024, 13(7), 2011; https://doi.org/10.3390/jcm13072011 - 29 Mar 2024
Cited by 2 | Viewed by 2373
Abstract
Obesity is associated with several chronic conditions including diabetes, cardiovascular disease, and metabolic dysfunction-associated steatotic liver disease and malignancy. Bariatric surgery, most commonly Roux-en-Y gastric bypass and sleeve gastrectomy, is an effective treatment modality for obesity and can improve associated comorbidities. Over the [...] Read more.
Obesity is associated with several chronic conditions including diabetes, cardiovascular disease, and metabolic dysfunction-associated steatotic liver disease and malignancy. Bariatric surgery, most commonly Roux-en-Y gastric bypass and sleeve gastrectomy, is an effective treatment modality for obesity and can improve associated comorbidities. Over the last 20 years, there has been an increase in the rate of bariatric surgeries associated with the growing obesity epidemic. Sleeve gastrectomy is the most widely performed bariatric surgery currently, and while it serves as a durable option for some patients, it is important to note that several complications, including sleeve leak, stenosis, chronic fistula, gastrointestinal hemorrhage, and gastroesophageal reflux disease, may occur. Endoscopic methods to manage post-sleeve gastrectomy complications are often considered due to the risks associated with a reoperation, and endoscopy plays a significant role in the diagnosis and management of post-sleeve gastrectomy complications. We perform a detailed review of the current endoscopic management of post-sleeve gastrectomy complications. Full article
(This article belongs to the Special Issue Sleeve Gastrectomy: Risks, Outcomes, and Complications)
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Graphical abstract

14 pages, 2370 KiB  
Review
The Art of Sleeve Gastrectomy
by Shahed Tish and Ricard Corcelles
J. Clin. Med. 2024, 13(7), 1954; https://doi.org/10.3390/jcm13071954 - 28 Mar 2024
Cited by 3 | Viewed by 2535
Abstract
Sleeve gastrectomy (SG) has historically evolved from gastroplasty and anti-reflux procedures into one of the most commonly performed primary metabolic surgeries in the United States and worldwide. Initially initiated in the 1980s as part of the duodenal switch procedure, its standalone effectiveness and [...] Read more.
Sleeve gastrectomy (SG) has historically evolved from gastroplasty and anti-reflux procedures into one of the most commonly performed primary metabolic surgeries in the United States and worldwide. Initially initiated in the 1980s as part of the duodenal switch procedure, its standalone effectiveness and simplicity have led to increasing popularity globally. The rise in obesity rates transcends age boundaries, alarmingly affecting not only adults but also the younger demographic. This escalating trend is concerning, as it predisposes these populations to numerous future health complications, as well as highlighting the critical necessity for a safe and potent weight loss strategy. Although sleeve gastrectomy carries a higher risk for gastroesophageal reflux disease (GERD) compared to other bariatric procedures, it stands out as a reliable, safe and effective surgical solution for obesity. It is particularly beneficial for adolescents and patients with complex medical comorbidities, including, but not limited to, heart failure and immunocompromisation. It has also served as a bridge for transplants in morbidly obese patients with end-stage heart, liver and kidney disease due to its favorable safety profile. Full article
(This article belongs to the Special Issue Sleeve Gastrectomy: Risks, Outcomes, and Complications)
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21 pages, 5765 KiB  
Review
Current Management and Treatment Paradigms of Gastroesophageal Reflux Disease following Sleeve Gastrectomy
by Muaaz Masood, Donald E. Low, Shanley B. Deal and Richard A. Kozarek
J. Clin. Med. 2024, 13(5), 1246; https://doi.org/10.3390/jcm13051246 - 22 Feb 2024
Cited by 1 | Viewed by 2622
Abstract
Obesity is associated with serious comorbidities and economic implications. Bariatric surgery, most commonly Roux-en-Y gastric bypass and sleeve gastrectomy, are effective options for weight loss and the improvement of obesity-related comorbidities. With the growing obesity epidemic, there has been a concomitant rise in [...] Read more.
Obesity is associated with serious comorbidities and economic implications. Bariatric surgery, most commonly Roux-en-Y gastric bypass and sleeve gastrectomy, are effective options for weight loss and the improvement of obesity-related comorbidities. With the growing obesity epidemic, there has been a concomitant rise in bariatric surgeries, particularly in sleeve gastrectomy, which has been the most widely performed bariatric surgery since 2013. Gastroesophageal reflux disease (GERD) is highly prevalent in obese individuals, can significantly impact quality of life and may lead to serious complications. Obesity and GERD both improve with weight loss. However, as the incidence of sleeve gastrectomy rises, recent data have revealed a risk of exacerbation of pre-existing GERD or the development of de novo GERD following sleeve gastrectomy. We performed a detailed review of GERD post-sleeve gastrectomy, including its overall incidence, pathophysiology and current treatment paradigms. Full article
(This article belongs to the Special Issue Sleeve Gastrectomy: Risks, Outcomes, and Complications)
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Other

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7 pages, 1079 KiB  
Brief Report
Verification of Safety and Efficacy of Sleeve Gastrectomy Based on National Registry by Japanese Society for Treatment of Obesity
by Shinichi Okazumi, Takashi Oshiro, Akira Sasaki, Hisahiro Matsubara and Ichiro Tatsuno
J. Clin. Med. 2023, 12(13), 4303; https://doi.org/10.3390/jcm12134303 - 27 Jun 2023
Cited by 3 | Viewed by 1279
Abstract
In Japan, bariatric surgical treatment was started in 1982. The Japanese Society for Treatment of Obesity (JSTO) was established in 2007, and then, JSTO started the national registry of bariatric surgery cases and multidisciplinary educational program. A total of 44 facilities registered 4055 [...] Read more.
In Japan, bariatric surgical treatment was started in 1982. The Japanese Society for Treatment of Obesity (JSTO) was established in 2007, and then, JSTO started the national registry of bariatric surgery cases and multidisciplinary educational program. A total of 44 facilities registered 4055 bariatric surgical cases until 2021. In this study, the purpose is to clarify the indication, the safety and the effectiveness of the sleeve gastrectomy using national registry database compiled by JSTO. Preoperative BMI ranged from 27.6 to 90.7 kg/m2, and the mean value was 42.7. With regard to gender, men/women was 1/1.3. Age was 42.2 as mean. As preoperative comorbidities, DM ratio was 54.4% of the patients, hypertension 64.5%, dyslipidemia 65.1%, and sleep apnea syndrome 69.8%. As an operation method, laparoscopic method was conducted in 99.7% of the cases. The intraoperative incidence rate was 0.9%. Conversion rate to open method was 1.1%. Postoperative morbidity ratio was 5.6%, and mortality was 0%. Reoperations were performed in 1.5% of the cases. Postoperative hospital stay was 5 days in median value. Body weight loss was 27.6 kg in the mean value after follow-up days of 279 ± 245. As the effect on the preoperative metabolic comorbidities, DM has improved in 82.9% of the cases, hypertension 67.9% and dyslipidemia 66.6%. In conclusion, using JSTO database, we evaluated the indication, postoperative complications and weight loss effect of sleeve gastrectomy in Japan. Regarding the evaluation of the effect on preoperative comorbidities, future follow-up based on more detailed criteria was considered to be necessary. Full article
(This article belongs to the Special Issue Sleeve Gastrectomy: Risks, Outcomes, and Complications)
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