Evelyn Dorado. FUNDACION VALLE DEL LILI
INTRODUCTION: Sleeve gastrectomy is more performed bariatric surgery at the time in the world, it has proved effective and very good long-term results, but despite being an easy surgery to perform, overlooking technical aspects of the surgery can lead a disastrous result like dysphagia, pain and excessive weight loss.
MAIN: Show how failed results after laparoscopic sleeve gastrectomy can be fixed with total or subtotal gastrectomy.
METHODS: 2 female patients with LSG, performed at another institution and asked a second opinion about there symptoms.
CASE 1: 26-y/o, quadriplegia secundary a traffic accident, BMI 32, 3 years ago LSG with 20% residual stomach measured on CT Scan. The patient has severe malnutrition with BMI 14, sacral bedsores, secondary osteomyelitis,and severe reflux, last endoscopy with Barrett's.
CASE 2: 38-y/o, BMI 38, 2 years ago LSG, after surgery vomited and severe dysphagia with exaggerated weight loss, and this studies: CT scan esophageal dilation, gastroesophageal juntion with stenosis and residual stomach 30%. Manometry: Hypertonic IEE , esophageal body motility decreased, endoscopy with stenosis in the gastroesophageal junction without passage to the distal stomach. albumin 4.
RESULT:
Case 1: The patient was recovered nutritionally ,preoperative albumin 2 and 3.7 after TPN and NE nutrition. Osteomyelitis was handled with antibiotic therapy and negative pressure. she underwent laparoscopic subtotal gastrectomy YenRoux . The patient was hospitalized 3 days, starting clear liquid diet the day after surgery. There was improvement in the food patron and currently without reflux symptoms with weight stabilization and now BMI 18.
CASE 2: gastric tube kicking with the fundus on the right side, moderate esophageal dilatation and a gastric reservoir 20% with stenosis in middle of tube was observe. I performed laparoscopy total gastrectomy with anastomosis esophagojejunal.She was hospitalized four days, with esophagogram negative for leaks. at 1 month after surgery tolerating soft diet and regain weight.
CONCLUSION: Bariatric surgery is helpful for patients with morbid obesity, but in Latin American countries not all surgeons who perform bariatric surgery have proper training, which does not guarantee the basic principles to avoid technical problems,in this cases sleeve gastrectomy with technical failures, which can lead to many problems in patients with catastrophic results and very aggressive revision surgeries. Is very important choose the right procedure for each patient but most important is verifed the expertise, trainning of bariatric surgeon, becouse we have the live of patients in our hands.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77774
Program Number: P157
Presentation Session: Poster (Non CME)
Presentation Type: Poster
