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In the recovery room, the nurse observes that the nasogastric tube was shorter, with staples fixed on its extremity (⋆).
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Bariatric surgery has become an integral part of morbid obesity treatment with well-defined indications. Some complications, specific or not, due to laparoscopic sleeve gastrectomy (LSG) procedure have recently been described. We report a rare complication unpublished to date: a nasogastric section during great gastric curve stapling. A 44-year-old...
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The use of weight reduction surgeries has increased over the years with a higher proportion of these surgeries being sleeve gastrectomies, this has been associated with some complications including staple line leaks. We report a 32-year-old male who had undergone a laparoscopic gastric band surgery and subsequently a laparoscopic sleeve gastrectomy...
Background: Laparoscopic Sleeve Gastrectomy (LSG) is one of the most used surgical techniques for the treatment of morbid obesity. The esophageal perforation (EP) secondary to the use of calibrating bougie is a rare complication.Case presentation: A 43-year-old woman with a body mass index (BMI) of 54 kg/m2 underwent LSG. During the use of a calibr...
Citations
... Mini gastric bypass (MGB) has recently emerged as one of the most popular procedures as it is safe, easy to learn and has remarkable results [2]. Bile reflux, marginal ulcers and gastric remnant cancer are some concerns associated with MGB [3]. Suturing of nasogastric/orogastric tube in bariatric procedures has been reported in past. ...
... Péquignot et al [3], Sharma D et al [4] and Higa G et al [5] had previously reported a case of impingement of nasogastric tube. ...
... The fact that, in our patient it was detected only at the time of extubation, shows that stapler firing can occur without the surgeon feeling any resistance at all. Others have also reported delayed detection of this complication [5,6]. ...
... Although the OGT must be removed prior to stapling as a rule, not only OGTs but thermal probes and even bougies were reportedly stapled and transected. [1][2][3][4][5][6][7][8][9][10][11] These iatrogenic misadventures, besides causing longer operations, were associated with major sequelae such as increased leak risk, [1,4,7] early [2,4] or late re-operations [8] and even death. [7] Published data is surprisingly scarce. ...
... Although the OGT must be removed prior to stapling as a rule, not only OGTs but thermal probes and even bougies were reportedly stapled and transected. [1][2][3][4][5][6][7][8][9][10][11] These iatrogenic misadventures, besides causing longer operations, were associated with major sequelae such as increased leak risk, [1,4,7] early [2,4] or late re-operations [8] and even death. [7] Published data is surprisingly scarce. ...
... The review initially identified 11 articles reporting on orally introduced tube entrapments during a bariatric surgery. [1][2][3][4][5][6][7][8][9][10][11] PRISMA chart is presented in Figure 1. One was an editorial comment, admitting to 2 previous bariatric operations where small-caliber OGTs were inadvertently stapled, without any further data [10] and excluded. ...
Background:
Entrapment of an orally introduced tube by stapling/stitching is an intra-operative complication of bariatric surgery with grave consequences. Incidence is unknown. No prevention/management strategy is available. A systematic review was performed to assess the absolute reported observed risk and incidence. Additionally, data on 3 cases during our entire sleeve gastrectomy (SG) experience is evaluated.
Methods:
Literature is reviewed using PubMed/Web of science data-bases. Data was recorded prospectively. Videos of orally introduced tube staplings were re-watched, presentation/recognition/management were re-evaluated. A protocol ensuring the removal of the small caliber orogastric tube (OGT) by the surgeons direct inspection was introduced after the 3rd entrapment.
Results:
Review revealed OGT as the most commonly entrapped tube following temperature probe and bougie. SG/stapling were the most common causative operation/reason, respectively. Leak rates over 20%, conversion, early-late re-operations and mortality were reported. During our 948 consecutive SGs, 3 OGT entrapments (0.32%), third one with double stapling, occurred. All were recognized/managed intraoperatively by freeing the entrapped-end of the OGT from the sleeve part of the staple-line. In doubly stapled case, second transected end could only be recognized when routine reinforcement suturing come in proximity. Defects were continuously stitched with barbed suture. No morbidity occurred. One-year excess-weight-loss was 82%. A pre-protocol incidence of 0.56% (n: 3/534) dropped to nil in the remaining 414.
Conclusion:
Iatrogenic stapling of the OGT during SG is rare, but morbid. It must be avoided by a strict protocol. Upon occurrence/recognition, stapling must immediately stop until the "entirety" of the tube, including the "specimen-part", is retrieved, to avoid double entrapment.
... Laparoscopic sleeve gastrectomy (LSG), introduced in 1990 as an alternative to distal gastrectomy, is an effective and safe procedure in the treatment of morbid obesity. However, a number of complications have been reported in the literature, such as iatrogenic oesophageal transection, 1 iatrogenic nasogastric (NG) perforation with a NG tube, 2 stapling and section of the NG tube during LSG, stapled NG tube misplaced into the airway, 3 and inadvertent intrapleural placement or placement into the bronchi. Early complications 4 that can arise include bleeding, staple-line leak, deep-vein thrombosis, pulmonary embolism and damage to the organs. ...
Laparoscopic sleeve gastrectomy is a safe and accepted procedure for morbid obesity to reduce weight with an overall low rate of complications; the incidence of major blood vessel injury reported in the literature is 0.1%. In our patient, sudden bradycardia and a fall in blood pressure and oxygen saturation were immediately identified. A camera was inserted and revealed bleeding under the first trocar, necessitating conversion of the laparoscopic procedure to laparotomy. Management included repair of injuries to the aorta and the inferior vena cava by the vascular surgeon, initial supportive therapy with crystalloids, and initiation of inotropic agents and vasopressor drugs. A predefined massive transfusion protocol of red blood cells, fresh-frozen plasma/cryoprecipitate and platelet units (random donor platelets) in each pack in a 1:1:1 ratio was followed.
... It comes with its own complications and paramount among them is a leak, which is comparatively to other techniques of bariatric surgery, probable in the proximal part of the long staple line 1,2 . However, rare complications like NG tube sectioning and stapling to the sleeve though possible is reported only once before this case 4 . In the only previous report the severed NG tube could only be detected in the postoperative period outside the operation room and hence they took the remnant out using an endoscope and closing laparoscopically. ...
... Gagner and Huang[22]published a study comparing the probe with a calibration system and suction, which facilitates insertion, prevents the corkscrew effect, and reduces operating times. Pequignot et al.[23]reported a rare case of retention of the bougie, diagnosed by the nurse when attempting to remove it in the immediate postoperative period, which was resolved by relaparoscopy assisted with endoscopy. Meshikhes and Al-Saif[24]had a case of complete esophageal transection during LSG that was not recognized during operation. ...
Laparoscopic sleeve gastrectomy (LFG) has become the most popular bariatric surgical operation. Based on the lesser curvature, the sleeve, is created with endo-staplers, which separate the lesser curvature longitudinally and vertically from the rest of the stomach including the greater curvature. The use of a bougie (Bougie, a medical instrument, used in an esophageal dilatation) helps to calibrate the diameter of the sleeve. Intra-operative bougie stapling (ISB) is a serious complication that should be prevented and when it happens correction is mandatory. We present three cases with a video.
... Additionally, intraluminal tubes such as temperature probes, OG tubes, and bougies have been inadvertently transected during stapling and creation of the sleeve [2,13,14]. At any time during surgery, a bougie can slip out of the unfinished sleeve, after which it can be easily transected proximally. ...
Placement of a bougie for sleeve sizing during laparoscopic sleeve gastrectomy (LSG) is recommended. We compared this standard with a suction calibration system (SCS) that performs all functions with one insertion, and measured each step's duration.
Primary LSG was performed using a bougie and SCS in alternating order. Number of tube movements to achieve optimal placement, durations of decompression, leak testing, and overall operative time, and remnant linear measurements were obtained.
LSG was performed in 26 patients (15 women, 11 men; mean age 36.8 years; mean BMI 45.3 kg/m(2)). The mean number of tube movements was significantly greater for the bougie than for the SCS (8.13 vs. 3.58; p < 0.0001). Percent reductions achieved using the SCS were: time to full decompression of the stomach, 62 % (21 vs. 8 s; p < 0.138); tube placement, 51 % (101 vs. 49 s; p < 0.0001); leak testing, 78 % (119 vs. 26 s; p < 0.0003); and mean operative duration (from tube insertion to end of stapling), 21 % (875 vs. 697 s; p < 0.019). Variance of the staple-line distance, measured from the greater curvature to the staple line, was 1.64 and 0.92 for the bougie and SCS, respectively, indicating a reduction in corkscrewing, for a 43.9 % straighter sleeve.
SCS maintained the gastric wall in place, thereby preventing corkscrewing, and reducing total operating time. Reducing the number of tube insertions may prevent esophageal damage and accidental tube stapling.
Laparoscopic sleeve gastrectomy is removal of major portion of the stomach especially the fundus, leaving only a thin gastric tube between the esophagus and the duodenum. Sleeve gastrectomy, one of the most popular bariatric surgeries in the modern era, is the easiest to learn and maintains the normal physiological continuity of gut. Complications inherent to surgical procedure can often be averted through vigilant adherence to checkpoints. We report a complication involving the stapling and entrapment of a nasogastric tube (NGT) during laparoscopic sleeve gastrectomy in a 45-year-old lady with severe obesity (BMI 42.1 kg/m²). Despite multiple unsuccessful attempts to remove the NG tube post-surgery, subsequent examination of the resected specimen in the pathology laboratory revealed a portion of the NG tube embedded in the staple line. Hence the part of NG tube caught up in the staple line was confirmed. The retained part of NG tube was successfully removed laparoscopically. She recovered well and was discharged on 4th post operative day. Since the saying goes; sharing is learning, we report this case for fostering awareness among colleagues to prevent encountering similar challenges, particularly given the prevalent use of staplers in contemporary surgical practices.
