Computed tomography assessment of postoperative gastric vascular supply and staple-line leak development after sleeve gastrectomy |
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| Affiliation: | 1. Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, Clamart, France;2. Paris-Saclay University, Orsay, France;3. Department of Radiology, Antoine Béclère Hospital, Clamart, France;4. Department of Hepato-Gastroenterology and Nutrition, Antoine Béclère Hospital, Clamart, France;5. Interventional Endoscopy Unit, Private Hospital Des Peupliers-Ramsay Santé, Paris, France;1. Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China;2. Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China;3. Laboratory of Data Discovery for Health Limited (D24H), Hong Kong Science Park, New Territories, Hong Kong, China;4. Research Department of Policy and Practice, University College London School of Pharmacy, London, United Kingdom;5. Division of Surgery, Chinese University of Hong Kong Medical Centre, Hong Kong, China;6. Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China;7. Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China;8. Health Economics and Health Technology Assessment, Institute of Health & Well-Being, University of Glasgow, United Kingdom;9. Department of Surgery, Prince of Wales Hospital, Hong Kong, China;1. Diabetes and Obesity Research Institute, Cedars-Sinai Medical Center, Los Angeles, California;2. Minimally Invasive and GI Surgery, Cedars-Sinai Medical Center, Los Angeles, California;3. Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California;1. Equipe de recherche AESIO Santé unité de Saint-Etienne, Clinique médicochirurgicale mutualiste, Saint-Etienne, France;2. URCIP (Unité de Recherche Clinique Innovation et Pharmacologie), University Hospital Saint-Etienne, Saint-Etienne, France;3. SAINBIOSE (SAnté INgéniérie BIOlogie St-Etienne), INSERM U1059, Université de Lyon, Saint-Etienne, France;4. Department of Digestive Surgery, University Hospital Saint-Etienne, Saint-Etienne, France;5. Department of Gastroenterology, University Hospital Saint-Etienne, Saint-Etienne, France |
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| Abstract: | ![]()
BackgroundResidual arterial supply of the gastric tube after sleeve gastrectomy (SG) can be damaged by surgery, which can reduce gastric tube perfusion and could promote postoperative leakage.ObjectiveTo compare the postoperative vascularization of the gastric tube using early computed tomography (CT) scanning after SG in patients with or without postoperative staple-line leak.SettingUniversity hospital.MethodsA retrospective analysis of a prospective database was performed in consecutive patients undergoing SG. Patients who presented with a staple-line leak were matched (1:3) with a control group of patients who underwent surgery without postoperative morbidity during the same period. Gastric tube vascularization was studied on a postoperative day 2 CT scan in both groups of patients.ResultsDuring the study period, 1826 patients underwent SG, including 42 patients (2.3%) who presented with a staple-line leak. Those 42 patients were successfully matched to 126 control patients. Global identification of residual gastric arterial supply in early postoperative CT scans was similar in patients with or without staple-line leak after SG. However, residual vascular supply of the gastroesophageal junction (i.e., terminal and anterior cardiotuberosity branches of the left gastric artery or left inferior phrenic artery) was more frequently interrupted by the staple line in the group of patients who developed a gastric leak.ConclusionThis study suggests a correlation between interruption of the main arteries supplying the gastroesophageal junction by the staple line on early postoperative CT scans and the development of gastric leak after SG. These results support the vascular theory as one of the causes of leak after SG. |
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| Keywords: | Obesity Bariatric surgery Sleeve gastrectomy Gastric vascular supply Computed tomography |
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