A new approach for leak after sleeve gastrectomy unique case report by mikeholy

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									A new approach for leak after sleeve
 gastrectomy-a unique case report

         IFSO 2010
Laparo-Obeso Centre
       Dr. Shah Shashank
      M.S., F.A.I.S., F.M.A.S.
  -Director – Dept. of Laparoscopic
      and Bariatric Surgery
-Dr.L.H.Hiranandani Hospital, Mumbai
         -Ruby Hall Clinic, Pune
        -Poona Hospital, Pune

   www.obesityasia.com
drshashankshah@rediffmail.com
    drshashanks@gmail.com
     Phone 09822026734
A new approach for leak after sleeve
 gastrectomy-a unique case report

Presenter Name: Dr. Shashank Shah


NO FINANCIAL DISCLOSURE
Sleeve Gastrectomy-Complications
• Leakage : multifactorial :most common ::
  difficult to treat
• Abscess
• Kinks / obstruction
• Gastro-oesophageal reflux
• Gastric fistula
• Haemorrhage Etc………………..
Long term complications:
• Malabsortion of Vit. And minerals
• Dilatation of sleeve
   Options for treatment of leaks

• Medical treatment:Enteral/ Parenteral feeding
         With percutaneous drain
• Suture repair
• Endoscopic stent
• fibrin sealing
               Case details
• Female 36 yrs BMI 42 kg/m2
• Impaired glucose tolerance, sleep apnea
• Underwent LSG
• First 48 hrs-uneventful, hemodynamically
  stable
• After 48 hrs-
   -mild tachycardia
   -sick look
• CT Scan abdomen-evidence of leak at GO
   Junction
• Laparoscopic lavage, adhesionolysis
  --leak site identified and sutured with 2-0
   vicryl, 3 interrupted sutures with omental
   patch
• Endoscopy-air leak test done
• Endoluminal stent was placed
                 Video
• Sent already
                   Results
• After 24 hrs-gastrograffin swallow to confirm
  no leak.
• Oral fluids started
• Discharged 4th day
• Stent removed after 3 weeks
• Recovery-uneventful
              Conclusion
• Intra operative leak test may remain
  fallacious to diagnose leaks. An
  aggressive timely approach with primary
  closure of leak and simultaneous
  endoluminal stent could be a better
  approach to deal with immediate post
  operative leaks after SG.
  Thank – You
Dr.Shashank Shah
Laparo-Obeso Centre, India
      Ph. +919822026734

 Email:drshashanks@gmail.com
 drshashankshah@rediffmail.com
    www.obesityasia.com
    www.laparo-obeso.com

								
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