1. SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY: THE EXPERIENCE OF A REFERRAL CENTER.
Dr. W. JAMAL, DES, DESC
Department of General Surgery
King Abdulaziz University Hospital - Jeddah

2. SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY: THE EXPERIENCE OF A REFERRAL CENTER.
Dr. W. JAMAL,
Prof. JM. CHEVALLIER
Department of General & Digestive Surgery,
HOPITAL EUROPEEN GEORGES POMPIDOU, APHP Paris - FRANCE

3. SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE

4. SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
Sleeve Gastrectomy And Bariatric Surgery
Popularity
Indications
Efficacity
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE

5. SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
Restrictive Procedure
Frequency
Effective weight loss
Resolution of co-morbidity
Effective
<
Difficult
<
Part Of BPD-DS
1st Step in super-super obese (BMI > 60)
Stand alone
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE

6. SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
13 Patients Transfered to HEGP after Sleeve
M = 1, F = 12
Age ( 35 – 60 ans)
3/13 SG (BPD-DS)
10/13 Sleeve (stand-alone)
5 after failed Band
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE

7. SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
Mrs. (1)
54 y.o
Failed Band
Sleeve Gastrectomy + BPD-DS
Gastric leak
Transferred to HEGP
Imaging: Lt. Oeso – Pleural Fistula + Abces
OR: Lavage + Drainage + J Feeding
Thoracic Drainage
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE

8. SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
Mme (1)
Decrease in Drainage
Resume Oral Intake
Discharged Home with Abdominal Drainage
Readdmition; Respiratory Distress and Pneumopathy (Recurrence Oeso-Pleural Fistula)
Antibiotic + Gastric Stent
- Recurrence Oeso-Pleural Fistula
OR: Total Gastectomy
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE

9. SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
Mrs. (2)
57 y.o
Gastric Band 1999, Removal of Band 2002
Sleeve G + BPD-DS on 16/11/2005
Gastric Leak at D11
OR: Well managed, Well tolerated
D18 upper GI Hg, OGD
D34 (Hemorragic Choc), Transfusion 12 PRBC
CT-Scan: Rupture of PseudoAnurism of SA
Transfered to HEGP
Embolisation
Dischared 1m
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE

10. SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
Mrs. (3)
43 y.o
Sleeve G 21 sept 2010
D2 Gastric Leak + Lt. sub-phrenic Abces
OR: Drainage + J Feeding +Antibiotic
Transferred to HEGP
Sepsis (Pneumopathy)
Failure Gastric Stent X 2
Clip OVESCO 15/12/2010
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE

11. SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
Mrs (4)
60 y.o
Sleeve G 22/7/2010
D3 Respiratory Distress
Barium Meal: NO Leak
CT-Scan: Perisplenic Fluid Collection
Antibiotic + Transferred to HEGP
CT-Scan2: Gastric Leak + Lt. Sub-Phrenic Collection + Lt. Pleural Effusion
OR: Intubation of Leakage Site by T-tube Drain + Drainage + J Feeding
Resume Oral Intake + Removal Of T-tube on October 2010
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE

12. SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
Mrs (5)
30 y.o
Sleeve Gastrectomy
Post-Op OK, BUT……
Progressive Food Intake Intolerance
3 OGD Unremarkable
Barium Meal ……..
What to do ??
TWIST
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE

13. SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
Mrs (6)
35 y.o
Failure Gastric Band Placement in 2008
21/10/ Failure Band ---} Sleeve
Stabling Calibration tube + important Hg
Conversion to Laparotomie, Anastomose Oeso-J
Methylen Blue Test Positive
ICU, Extubation at D1, fever 40, WBC 20000
CT-Scan D2, 2 Leaks
Transferred to HEGP
OR: Intubation of Leakage site (Spirale)
Resume Oral Intake on March 2011
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE

14. SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
DIAGNOSTIQUE N= Tx
PseudoAnurism Embolisation
Gastro-Cutaneous Fistula Clips
Oeso-Gastric Leaks Drainage,1Clip, 1TG
Calibration tube Stapling TG
Gastropleural Fistula TG
Abces Drainage
Twist Stent
Mean Length of Hospital Stay = 60 Jours ( 13, 135)
Mean Number of Admission = 1.9 Hospi (1, 4)
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE

15. SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
CONCLUSION:
Sleeve Gastrectomy is an effective weight loss procedure, despite its complications which are rare, it could be serious and considerably extend the legnth of hospital stay, with important fonctional and psychological consequences on patients.
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE

16. SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE

17. SERIOUS COMPLICATIONS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
HOPITAL EUROPEEN GEORGES POMPIDOU – APHP Paris - FRANCE
PARIS-WISAM JAMAL