Our Summary

This research paper looks at how effective a certain type of procedure (endoscopic management) is at treating a specific complication that can arise after a type of weight loss surgery (sleeve gastrectomy). The complication is called “twisting of the gastric pouch” and it causes symptoms similar to a blockage in the stomach.

The researchers looked at data from 860 patients who had undergone this weight loss surgery at Ain Shams University Hospital between May 2017 and January 2019. Of these, 32 patients (around 3.7%) developed symptoms of this blockage. However, after excluding some for various reasons, only 22 patients (2.5%) who had a confirmed twist in their gastric pouch were included in the study.

These patients were mostly women (72%), with an average age of 41. They started showing symptoms about 40 days after their surgery. The researchers used different methods to confirm the diagnosis, including a special type of x-ray (Gastrografin contrast study) and 3D CT scans.

These patients then underwent an endoscopic procedure, which involves inserting a small camera and instruments through the mouth and into the stomach. This was done about 40 days after their surgery. The procedure was successful in 20 out of 22 patients (91%), meaning their symptoms were relieved and the twist in their stomach was corrected.

One patient had a narrowing in their esophagus after the procedure, which required further treatment. In two patients (9%), the procedure did not work, and they had to undergo further surgery.

In conclusion, although the twisting of the gastric pouch is a rare complication of weight loss surgery, it seems to be happening more often. However, the use of an endoscopic procedure to insert a stent is very effective at treating this problem and should be tried before any further surgery is considered.

FAQs

  1. What was the success rate of endoscopic intervention in patients diagnosed with twist after gastric sleeve surgery?
  2. What were the common symptoms observed in patients who experienced gastric pouch twisting after sleeve gastrectomy?
  3. Is endoscopic stent insertion recommended as a first step before any further surgical intervention in cases of gastric pouch twisting after sleeve gastrectomy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about gastric sleeve surgery is to be aware of the potential complication of gastric pouch twisting. It is important to recognize the symptoms of obstruction and seek medical attention promptly. Endoscopic stent insertion can be a highly effective treatment for gastric pouch twisting after sleeve gastrectomy, so it is important to discuss this option with your healthcare provider. Early intervention can lead to successful management and relief of symptoms.

Suitable For

Patients who are typically recommended for gastric sleeve surgery are those who have a body mass index (BMI) of 40 or higher, or a BMI of 35 or higher with obesity-related health conditions such as diabetes, high blood pressure, or sleep apnea. They should have tried and failed to lose weight through diet and exercise alone, and be committed to making lifestyle changes to support their weight loss journey. Additionally, patients should be in good overall health and have a willingness to follow up with their healthcare team for long-term monitoring and support.

Timeline

  • Before gastric sleeve:
  1. Patient undergoes pre-operative evaluation and consultation with a bariatric surgeon.
  2. Patient follows pre-operative diet and exercise guidelines to prepare for surgery.
  3. Patient undergoes gastric sleeve surgery, which involves removing a portion of the stomach to create a smaller pouch.
  4. Patient is monitored post-operatively for any complications or side effects.
  • After gastric sleeve:
  1. Patient experiences initial weight loss and adjusts to smaller stomach capacity.
  2. Patient follows post-operative diet and exercise guidelines to promote weight loss and prevent complications.
  3. Patient may experience symptoms of twisting of the gastric pouch, such as obstructive symptoms.
  4. Patient undergoes diagnostic tests, such as Gastrografin contrast study and 3D contrast CT, to confirm diagnosis of gastric pouch twist.
  5. Patient undergoes endoscopic intervention, such as stent insertion, to manage twisting of the gastric pouch.
  6. Endoscopic treatment is successful in most cases, with complete relief of symptoms and correction of the gastric pouch axis.
  7. Patient may require further surgical intervention if endoscopic treatment fails.
  8. Patient continues follow-up care with bariatric surgeon to monitor progress and address any concerns.

What to Ask Your Doctor

Some questions a patient should ask their doctor about gastric sleeve surgery include:

  1. What are the potential complications of gastric sleeve surgery, such as gastric pouch twisting, and how are they typically managed?
  2. How common is gastric pouch twisting after gastric sleeve surgery?
  3. What are the symptoms of gastric pouch twisting that I should watch out for after surgery?
  4. How is gastric pouch twisting diagnosed, and what tests may be necessary to confirm the diagnosis?
  5. What are the treatment options for gastric pouch twisting, and what are the success rates of each option?
  6. Is endoscopic stent insertion a common treatment for gastric pouch twisting after sleeve gastrectomy, and what is the recovery process like after this procedure?
  7. Are there any long-term implications or risks associated with gastric pouch twisting and its treatment?
  8. How can I prevent complications like gastric pouch twisting after gastric sleeve surgery?
  9. Are there any lifestyle changes or dietary modifications that can help reduce the risk of gastric pouch twisting or other complications following surgery?
  10. What follow-up care or monitoring will be necessary after gastric sleeve surgery to detect and address any potential complications, such as gastric pouch twisting?

Reference

Authors: Hassan MI, Khalifa MS, Elsayed MA, ElGhamrini YM. Journal: Obes Surg. 2020 Aug;30(8):2877-2882. doi: 10.1007/s11695-020-04641-x. PMID: 32358685