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WJOLS

Sanjay Patolia, Ibrahim Hazza 10.5005/jp-journals-10033-1300
CaSe RepORt

Laparoscopic Management of Stomach Sleeve

Obstruction after Sleeve Gastrectomy

2
1 Sanjay Patolia, Ibrahim Hazza

ABSTRACT However, it is also associated with few complications,
Introduction: Stomach sleeve obstruction can occur after such as leak, bleeding, reflux, and food intolerance. 1,7
sleeve gastrectomy (SG). It results in absolute intolerance Stomach is stabilized at two fixed points, the cardia
to liquid and food intake. The obstruction of sleeve may be and pylorus. It is further held in position by the gastro-
because of stomach torsion, twisting, kinking, folding, adhe-
sions, and stenosis/narrowing. phrenic, splenic, colic, and hepatic ligaments.
We present a case report of two patients with absolute In case of SG, the stomach is to be mobilized com-
intolerance to liquid intake because of sleeve obstruction. The pletely by dividing all the structures supporting stability
reason for obstruction was folding, twisting, and partial torsion
of the stomach sleeve after SG. of the stomach. The dissection makes the stomach sleeve
Case/technique description: Two patients with absolute free. This will make it susceptible for twist, torsion,
1
intolerance to liquid intake were received on day 5 and on day folding, or kinking, resulting in obstruction of the lumen.
12 after undergoing primary laparoscopic SG. Intractable vomiting, nausea, and absolute intolerance to
The endoscopy findings were similar in both the cases. It
was not possible to reach pylorus without great difficulty and liquid and food intake are because of obstruction of the
high level of maneuverability. sleeve. Gastric torsion is the terminology used for the case
The laparoscopic findings were twisting and partial torsion operated for stomach surgery, whereas gastric volvulus is
due to laxity of the sleeve. Gastropexy was done in both the
cases. The recovery in terms of excellent tolerance for liquid used in the case of nonoperated stomach. Gastric torsion
intake was immediate and that too without recurrence. can be organoaxial (completely along the long axis) and
Discussion: The distal passage for food and liquid in the lumen mesenteroaxial (partial along the horizontal axis). 1
of the sleeve should remain very smooth. The lumen can accept The architecture (morphology) of the sleeve is a very
arrival of the Ryle’s tube or gastric calibration tube up to antrum
without any great assistance. This will not be possible in case critical aspect in the development of sleeve obstruction.
of improper architecture of the crafted sleeve. The design of the The proper techniques of dissection and stapling are
sleeve may be improper from the beginning or it may mutate very important technical issues to craft the sleeve with
because of abnormal adhesion at any time during postopera-
tive course. Symptoms and endoscopic findings are diagnostic perfect architecture, which gives almost vomiting-free
of the problem. Laparoscopic correction of the architecture of postoperative recovery. 2
the sleeve by doing adhesiolysis and gastropexy is successful. The established treatment for obstructed sleeve is to
Keywords: Gastric sleeve kinking, Gastric sleeve obstruc- convert it into gastric bypass, but adhesiolysis and mean-
tion, Gastric sleeve twisting, Gastric torsion, Gastric volvulus, ingful gastropexy can be successful correction. 3
Gastropexy, Sleeve gastrectomy.
How to cite this article: Patolia S, Hazza I. Laparoscopic CASE REPORTS
Management of Stomach Sleeve Obstruction after Sleeve
Gastrectomy. World J Lap Surg 2017;10(1):40-43. Case 1
Source of support: Nil
A 26-year-old female with body mass index (BMI) 37
Conflict of interest: None
underwent SG and was discharged on the 3rd postop-
INTRODUCTION erative day. She presented with severe liquid intolerance
and intractable vomiting on the 5th postoperative day.
Sleeve gastrectomy (SG) has earned huge popularity as Upper gastrointestinal (GI) endoscopy revealed relative
an effective, safe, reproducible, fast, and easy bariatric obstruction of the sleeve.
procedure.
Endoscopy Finding
1,2 Surgeon The endoscope was not possible to reach pylorus without
1,2 Department of Bariatric and Metabolic Surgery, Asian Bariatric great difficulty and high level of maneuverability (Fig. 1).
Center, Ahmedabad, Gujarat, India
Corresponding Author: Sanjay Patolia, Surgeon, Department Laparoscopic Findings
of Bariatric and Metabolic Surgery, Asian Bariatric Center
Ahmedabad, Gujarat, India, Phone: +919825183170, e-mail: The upper two-thirds of the gastric sleeve was twisted
drsmpatolia@yahoo.co.in
at the level of incisura angularis (Fig. 2). It was possible
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