20 Feb 2024Case Report
Late Complications after Laparoscopic Longitudinal Gastrectomy – Case Report
Razvan-Marius Ion 1Alexandra Scurtu 1Daniela Sala 1Radu Neagoe 1Tamas Szekely 2Renata Moriczi 2Mircea Muresan 1Ruxandra Daniealopol 2Valentin Daniealopol 1Aurelio Russo 3Gabriel Popescu 1
Affiliations
Article Info
1 Second Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
2 Second Department of Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
3 George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
Ann. Ital. Chir., 2024, 95(1), 1-5;
Published: 20 Feb 2024
Copyright © 2024 The Author(s).
This work is licensed under a Creative Commons Attribution 4.0 International License.
Abstract
Introduction: Bariatric surgery is now widely regarded as the most effective treatment for morbid obesity. It aims to enhance patients' health by achieving long-lasting weight loss, reducing associated comorbidities, and improving their quality of life. Case Report: The case involves a 51-year-old female patient who underwent sleeve gastrectomy eight years ago to address morbid obesity (Body Mass Index (BMI) = 43). Subsequently, the patient developed gastric obstructive syndrome, leading to diagnostic investigations including repeated upper digestive endoscopies and native computed tomography. These examinations revealed the presence of a hiatal hernia. In 2021, the patient underwent fundoplication type Dor with anterior hemivalve. However, post-surgery, the patient's condition did not improve, with persistent symptoms including regurgitation, heartburn, difficulty ingesting food, sensation of gastric fullness, and epigastralgia. Further exploratory procedures, including upper digestive endoscopy, abdominal computed tomography with contrast substance, and barium transit with contrast substance, led to the diagnosis of mediogastric stenosis postgastrectomy longitudinal, necessitating surgical intervention. This finding prompted a surgical approach involving distal gastric resection and restoration of digestive tract continuity through Hoffmeister-Finsterer gastro-jejunal anastomosis. Following the surgery, the patient's postoperative symptoms showed improvement. Discussion: Several other studies have demonstrated that the incisura angularis is the most common site of obstruction, as was observed in our study. This particular location appears to be more prone to narrowing, likely attributable to its angular shape. The linear staple line in this area can create a locus minoris resistentiae for kinking, as well as increase the risk of true stenosis if stapling is performed too close to the incisura angularis. Conclusions: Bariatric surgery should not be considered as the initial treatment option. However, in cases where it becomes necessary, postoperative monitoring is essential to prevent complications or address them promptly.
Keywords
- sleeve gastrectomy
- morbid obesity
- complications