Introduction
In bariatric surgery, the possibility of complications remains considerable due to the nature of the surgical invasion. In this regard, the particularities of individuals who undergo a laparoscopic sleeve gastrectomy are a subject of intense interest among clinical experts and researchers on a worldwide level. More specifically, this operation is the most common procedure performed within the scope of bariatric surgery. It serves to reduce the size of the patient’s stomach physically in order to instigate weight loss. The procedure itself is highly complicated due to the scale of the surgical invasion. Furthermore, laparoscopic sleeve gastrectomy is prescribed not for cosmetic purposes but in cases when non-invasive methods of weight loss fail to accomplish the envisaged objective. Thus, it remains a matter of last resort for patients who develop serious complications amid the presence of excessive body weight.
As such, laparoscopic sleeve gastrectomy is often performed with the background of severe underlying conditions that enable the development of major complications. These complications, combined with the possible post-surgery issues, pose a serious threat to the life and well-being of an individual. Post-laparoscopic sleeve gastrectomy leaks are one of the major problems that appear in the fallout of the surgery. The bariatric surgical community has been working on effective solutions that prevent this complication or mitigate its impact on the patient. Among them, the use of the stent is one of the viable approaches. This paper aims to analyze the contemporary body of knowledge in order to discuss the use and applicability of stents in patients with post-laparoscopic sleeve gastrectomy leaks.
Review of the Literature
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Within the current body of knowledge, the importance of bariatric surgery procedures is reflected in the number of studies devoted to both theoretical and practical research on its repercussions. This field of medicine possesses several prominent approaches to restoring the quality of life of patients with extreme weight gain. When other, non-invasive options fail to yield substantial results, bariatric surgeries become the only feasible solution. According to Deslauriers et al. (2018), laparoscopic sleeve gastrectomy (LSG) is the most common operation performed within this field. Thus, the investigation of its potential complications, as well as the most effective techniques of their mitigation, is a matter of topical status for the bariatric expert community.
Among the various complications of this procedure, gastric leak retains one of the leading positions, which is further instigated by its severe impact on the patient’s health. Bashah et al. (2020) report an incidence rate of post-laparoscopic sleeve gastrectomy leak between 1.5% and 3% of all cases. These numbers are considerable and alarming, implying that bariatric surgery specialists encounter this particular complication on a rather regular basis. In fact, Bashah et al. (2020) state that “staple line leakage is the second most common cause of death after bariatric surgery with an overall mortality rate of 0.4%” (p. 516). In this research, the authors rely on a retrospective approach to the analysis of post-LSG gastric leak cases. According to their findings, the global trends point toward a continuous decrease in the incidence rate of post-LSG leaks, but the presenting mortality still poses reasons for concern. Bashah et al. (2020) acknowledge the effectiveness and conservation effect of endoscopic stenting while addressing the complications of this method. Thus, they consider the key to proper post-LSG leak management to lie in the domain of multimodality.
When a post-LSG patient develops complications, clinical experts aim to prevent his or her condition from deteriorating further. Indeed, this type of bariatric surgery is frequently performed amid serious conditions, the onset of which is conditioned by continuous obesity. Thus, it is natural to avoid excessive surgical invasions, swaying the expert community toward endoscopic methods of mitigation. Aydin et al. (2016) confirm this tendency, adding that endoscopic stenting becomes the preferred method of post-LSG leak management for the field of bariatric surgery. Based on professional accounts, this approach exhibits smaller patient health-related risks as compared to re-laparoscopy, laparotomy, or percutaneous drainage. Modern hospitals continuously increase the use of this efficient and non-damaging method. Aydin et al. (2016) evaluated its efficacy in the practical clinical environment. Four patients had stents installed in the first-month post-surgery and had them retrieved in one, two and a half, or five months later. The examination revealed complete healing of the post-LSG leak without the development of further complications. Thus, the applicability of the stenting method in the clinical environment has practical confirmations. Nevertheless, subsequent studies with a larger sample may reveal varying outcomes.
Considering the development of medical technologies, the reported incidence rate range of post-LSG gastric leaks varies, as well. For Aydin et al. (2016), this number remains between 1.5% and 5%, whereas Abdelhamid et al. (2020) report an incidence of 1.9% – 2.4%. However, the rates remain alarming, as conditioned by the magnitude of the consequences of this condition. Abdelhamid et al. (2020) investigate the methodological dichotomy of endoscopic stenting versus surgical intervention as the means of addressing post-LSG gastric leaks. A sample of thirty patients with this complication was randomly divided into two equal study groups, corresponding with the two leading methods of leak management. The empirical data aligned with the prior theoretical findings, suggesting that endoscopic stenting is a more effective method of post-LSG leak management with lower morbidity and complication risks. In addition, the efficacy of this method grows further with early identification of the leak. The primary positive effect consists of better patient outcomes with a higher likelihood of successful recovery. On a secondary level, endoscopic stenting is associated with a shorter post-surgery hospital stay, reducing the cost of care for patients and organizations.
Discussion
For bariatric surgery specialists, the prevalence of post-LSG gastric leaks remains a pressing concern. As such, it is natural and vital to seek new effective solutions for managing the complications in a way that does not inflict further damage on the patient’s systems. The interest in endoscopic methods, namely stenting, receives in-depth explanations within the current body of literature. More specifically, the traditional alternatives rely on invasive surgical procedures that may contribute to severe complications amid other pre-existing conditions. The use of stenting aims to alleviate the damaging impact of post-surgery complications by endoscopic operations that do not require subsequent surgical interventions. For a physician, the potential benefits of stenting appear highly relevant and promising. This approach to post-LSG leak management leads to improved outcomes for patients who already present severe conditions. Through endoscopic interventions, the well-being of the patient is preserved to a better extent, thus enhancing the efficiency of the system.
Furthermore, from a professional perspective, the decreased duration of postoperative stay is another major benefit. Reducing the costs of care is important and topical in the current environment because it enables better utilization of the finite resources within the sphere of healthcare. At the same time, the workload of physicians and nurses is also alleviated, which leads to better concentration and performance of medical units. Therefore, based on the analysis of the contemporary body of knowledge, endoscopic stenting is a perfectly viable means of post-LSG leak management.
Conclusion
Ultimately, the efficiency and outcomes of bariatric surgery are a matter of paramount importance for both patients and health service providers. Among its procedures, laparoscopic sleeve gastrectomy is the most commonly performed surgery that, however, is associated with major complications. Post-LSG gastric leaks are one of such complications that pose major risks to the well-being of the patient. In this regard, the traditional approach to leak management has consisted primarily of surgical interventions. Such operations instill additional risks for patients who are already in a complicated position. Thus, the current tendency points toward the effectiveness of endoscopic methods, namely stenting. The existing body of knowledge recognizes its importance in the sphere of bariatric surgery. Based on the theoretical and empirical data, stenting is a safer and more reliable method of healing post-LSG leaks with better outcomes for the patients. Through the research of better and safer intervention practices, bariatric surgery will become more efficient, meeting its overarching purpose.
References
Abdelhamid, M. S., Gharib, A. K., Mohammed, M. A., & El Gindy, T. M. I. (2020). Leakage after sleeve gastrectomy: Endoscopic stenting VS surgical intervention. Archives of Surgery and Clinical Research, 4, 29–34.
Aydin, M. T., Alahdab, Y. O., Aras, O., Karip, B., Onur, E., Iscan, Y., & Memişoğlu, K. (2016). Endoscopic stenting for laparoscopic sleeve gastrectomy leaks. Turkish Journal of Surgery, 32(4), 275–280. Web.
Bashah, M., Khidir, N., & El-Matbouly, M. (2020). Management of leak after sleeve gastrectomy: Outcomes of 73 cases, treatment algorithm and predictors of resolution. Surgical Endoscopy, 30, 515–520.
Deslauriers, V., Beauchamp, A., Garofalo, F., Atlas, H., Denis, R., Garneau, P., & Pescarus, R. (2018). Endoscopic management of post-laparoscopic sleeve gastrectomy stenosis.Surgical Endoscopy, 32(2), 601–609.