Carrières-sous-Poissy, France
Carrières-sous-Poissy, France

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AlSabah S.A.,Amiri Hospital | AlRuwaished M.,Amiri Hospital | Almazeedi S.,Amiri Hospital | Al Haddad E.,Amiri Hospital | Chouillard E.,Paris Poissy Medical Center
Obesity Surgery | Year: 2017

Background: Laparoscopic sleeve gastrectomy (LSG) is today one of the leading procedures in bariatric surgery, and portomesenteric vein thrombosis (PMVT) has been reported as one of its rare complications. The purpose of this study is to determine the prevalence, clinical presentation, and outcomes of PMVT in patients undergoing LSG. Methods: A retrospective study of a database of all post-LSG patients was conducted on the patients who developed PMVT post-LSG from July 2011 to March 2016, at Amiri Hospital, Kuwait. Results: A total of 2280 patients underwent LSG during the study period. Nine (0.39%) patients were diagnosed with PMVT post-LSG. Diagnosis was confirmed by CT scan for eight patients, and one had urgent laparotomy. The median age was 34 years (20–50), and there were 7 women and 2 men. Median preoperative body mass index (BMI) was 42 kg/m2 (37.5–74.6), and median operative time was 80 min (60–150). The median post-operative anticoagulation duration was 4 days (2–22). The median onset of diagnosis after the surgery was 28 days (18–453), and two patients had a positive thrombophilia study. All patients were treated medically except one patient who underwent urgent laparotomy for small bowel necrosis and eventually had small bowel transplant. Conclusions: PMVT post-LSG is a rare but possibly dangerous complication. It should be suspected with patients presenting with unresolving abdominal pain. Treatment is mainly conservative and surgical intervention might be needed for small bowel necrosis. Extended anticoagulation prophylaxis is a hypothesis for patients after LSG, and may play a role in preventing PMVT. © 2017 Springer Science+Business Media New York


Elie C.,Paris Poissy Medical Center | Antoine Y.,Bellevue Medical Center | Mubarak A.,AlSabah Hospital | Ronald D.,Paris Poissy Medical Center | And 3 more authors.
Surgical Endoscopy and Other Interventional Techniques | Year: 2015

Background: Sleeve gastrectomy (SG) is currently the most commonly performed bariatric procedure in France. It achieves both adequate excess weight loss and significant reduction in comorbidities. However, fistula is still the most common complication after SG, occurring in more than 3 % of cases, even in specialized centers (Gagner and Buchwald in Surg Obes Relat Dis 10:713–723. doi:10.1016/j.soard.2014.01.016, 2014). Its management is not standardized, long, and challenging. We have already reported the short-term results of Roux-en-Y fistulo-jejunostomy (RYFJ) as a salvage procedure in patients with post-SG fistula (Chouillard et al. in Surg Endosc 28:1954–1960 doi:10.1007/s00464-014-3424-y, 2014). In this study, we analyzed the mid-term results of the RYFJ emphasizing its endoscopic, radiologic, and safety outcome. Methods: Between January 2007 and December 2013, we treated 75 patients with post-SG fistula, mainly referred from other centers. Immediate management principles included computerized tomography (CT) scan-guided drainage of collections or surgical peritoneal lavage, nutritional support, and endoscopic stenting. Ultimately, this approach achieved fistula control in nearly two-thirds of the patients. In the remaining third, RYFJ was proposed, eventually leading to fistula control in all cases. The mid-term results (i.e., more than 1 year after surgery) were assessed using anamnesis, clinical evaluation, biology tests, upper digestive tract endoscopy, and IV-enhanced CT scan with contrast upper series. Results: Thirty patients (22 women and 8 men) had RYFJ for post-SG fistula. Mean age was 40 years (range 22–59). Procedures were performed laparoscopically in all but 3 cases (90 %). Three patients (10 %) were lost to follow-up. Mean follow-up period was 22 months (18–90). Mean body mass index (BMI) was 27.4 kg/m2 (22–41). Endoscopic and radiologic assessment revealed no persistent fistula and no residual collections. Conclusions: Despite the lack of long-term follow-up, RYFJ could be a safe and feasible salvage option for the treatment of patients with post-SG fistula, especially those who failed conservative management. Mid-term outcome analysis confirms that fistula control is durable. Weight loss panel is satisfactory. © 2015 Springer Science+Business Media New York

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