Our Summary

This research paper discusses a rare but serious complication that can occur shortly after a common weight-loss surgery called laparoscopic sleeve gastrectomy (LSG). This surgery, where a large part of the stomach is removed, is frequently performed in the USA. One common long-term complication is a hiatal hernia, where part of the stomach pushes up into the chest. However, this paper focuses on a less discussed issue that can happen soon after the surgery, where the remaining part of the stomach moves into the chest. The authors describe a case where a young woman had severe vomiting shortly after LSG. Using a combination of different medical imaging techniques, doctors were able to clearly see that the stomach had moved into the chest, and she needed immediate surgery to fix this. The paper highlights the importance of radiologists being able to spot this issue on scans to ensure that patients are treated quickly. This can help to reduce the risks associated with this rare complication, improving patient safety and results.

FAQs

  1. What is a common chronic complication of laparoscopic sleeve gastrectomy?
  2. What symptoms might suggest an acute complication like incarcerated intrathoracic migration of the gastric sleeve after LSG?
  3. How important are UGI and CT scans in diagnosing complications after laparoscopic sleeve gastrectomy?

Doctor’s Tip

A doctor might tell a patient who has undergone a gastrectomy to carefully follow post-operative instructions, including maintaining a proper diet and avoiding overeating to prevent complications such as hernias or intrathoracic migration of the staple line. It is important to seek medical attention if experiencing severe and sudden symptoms such as intractable vomiting, as this could be a sign of a serious complication that may require immediate intervention. Regular follow-up appointments with healthcare providers are essential to monitor recovery and ensure optimal outcomes.

Suitable For

Patients who are typically recommended gastrectomy include those who are severely obese and have failed to achieve weight loss through other means such as diet and exercise. Additionally, patients with obesity-related comorbidities such as diabetes, hypertension, and sleep apnea may also be recommended for gastrectomy. It is important for patients to undergo a thorough evaluation by a multidisciplinary team including a bariatric surgeon, dietitian, psychologist, and other specialists to determine if gastrectomy is the appropriate treatment option for them.

Timeline

Before gastrectomy:

  1. Patient undergoes pre-operative evaluations and consultations with the surgeon, dietitian, and other healthcare providers.
  2. Patient may be required to follow a specific pre-operative diet and lifestyle changes to prepare for surgery.
  3. Patient undergoes the gastrectomy procedure, which can be either open or laparoscopic.
  4. Patient is monitored closely in the immediate post-operative period for any complications or side effects.

After gastrectomy:

  1. Patient is closely monitored in the hospital for a few days to ensure proper healing and recovery.
  2. Patient may experience some pain, discomfort, and nausea in the days following surgery.
  3. Patient is gradually transitioned to a liquid diet, followed by a pureed diet, and then solid foods.
  4. Patient undergoes regular follow-up appointments with the healthcare team to monitor progress and address any concerns.
  5. Patient may need to make significant lifestyle and dietary changes to adjust to the new stomach size and function.
  6. Patient may experience weight loss and improvements in overall health and quality of life in the months and years following gastrectomy.

What to Ask Your Doctor

  1. What are the potential risks and complications of gastrectomy surgery?
  2. How long is the recovery period after gastrectomy surgery?
  3. Will I need to make any dietary or lifestyle changes after the surgery?
  4. What follow-up care will be necessary after the surgery?
  5. How will gastrectomy surgery affect my long-term health and weight loss goals?
  6. What signs or symptoms should I watch out for that may indicate a complication after surgery?
  7. How often will I need to have follow-up appointments with you after the surgery?
  8. Are there any specific medications or supplements I should be taking after the surgery?
  9. Will I need any additional imaging tests or procedures to monitor for complications after surgery?
  10. What should I do if I experience any unexpected symptoms or concerns after the surgery?

Reference

Authors: Elsherif SB, Sharma SK, Sharma S, Zulia Y, Kumar S, Sharma S. Journal: Emerg Radiol. 2023 Dec;30(6):811-816. doi: 10.1007/s10140-023-02182-1. Epub 2023 Nov 7. PMID: 37934315