RISK ASSESSMENT OF EARLY POSTOPERATIVE COMPLICATIONS IN LAPAROSCOPIC SLEEVE GASTRECTOMY AND WAYS OF THEIR PREVENTION
Keywords:
Morbid obesity, body mass index, laparoscopic sleeve gastrectomy, leak and bleeding of the staple lines.Abstract
Optimization of the laparoscopic sleeve gastrectomy (LSG) technique for the prevention of perioperative complications
in patients with morbid obesity. Materials and methods: The study included the results of treatment of 45 patients
with morbid obesity who underwent LSG in 2014-2019 in the department of endovisual surgery. Among the patients, there were
35 women and 10 men (age 37,1±1,2 years; BMI 45,6±1,1 kg/m²). Results: Various complications associated with tactical and
technical aspects during the LSG and the first 2 days after surgery were observed in 4 (8.8%) patients. The frequency of failure
(leak) of the staple lines was 2.2% (1 patient), intra-abdominal bleeding and bleeding of the staple lines – in 4.4% (2 patients),
bleeding from separated gastroepiploic vessels after mobilization of the stomach along the greater curvature in 2,2% (1 patient).
It is noted that one of the most specific sections of the zone of interest when performing LSG and the likelihood of both
intra- and postoperative complications is the proximal part of the stomach when mobilizing the latter, the gastroesophageal
transition with the His angle, the proximal part of the “gastric sleeve” formed. For better endovisualisation of the stomach, calibration
and determination of the longitudinal line of the stapled hardware suture, a special bariatric gastric bougie has been
proposed for intraoperative intraluminal light curvature marking during LSG. Conclusions: LSG provides maximum weight
loss (% EWL) = 83.2% 12 months after the intervention and a stable restrictive effect for 2-3 years after surgery, when the%
EWL is not less than 94%. Bleeding from the stapler suture line and the inconsistency of the proximal segment of the formed
gastric “tube” are the most formidable specific complications of LSG. The most important in terms of eliminating these complications
are the timing of their diagnosis and timely decision-making on reoperation - relaparoscopy.
