Page 45 - World Journal of Laparoscopic Surgery

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Laparoscopic Management of Stomach Sleeve Obstruction after Sleeve Gastrectomy
by an experienced and exposed endoscopist. When it is early postoperative period and folding, kinking, or
extremely difficult and requires high level of maneuver- torsion due to adhesion at any time in the postopera-
ability to reach the pylorus, it is indicative of twisting or tive period.
partial torsion. The spiral appearance of the mucosal fold Nonjudicious overdissection, improper technique of
indicates total torsion of the sleeve. stapling, and nonvigilance are responsible for improper
After failure of conservative treatment, focus should final architecture of the sleeve. This will create problem
be on surgical correction of the architecture of the sleeve. of intolerance for liquid intake.
Tips to perform result-oriented gastropexy. The obstructive symptoms along with signs of
• Careful adhesiolysis of sleeve, making it free all dehydration, hypovolemic shock, oliguria, nutritional
around. deficiency, and endoscopy are the most effective tools to
• Pass GCT Fr 36 gently and observe the levels of diagnose the situation of obstructed sleeve.
holdup. Laparoscopic adhesiolysis and gastropexy are
• Try to correct the architecture of the sleeve by holding/ effective corrections. Conversion to gastric bypass can
pressing it with the help of graspers. Request to push be avoided if gastropexy is possible to be performed
GCT repeatedly, and it should reach up to the antrum meaningfully.
without holdup in between. This confirms proper
correction and also gives idea of the places for the REFERENCES
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