Our Summary

This research paper discusses a serious but rare complication that can occur after a weight-loss surgery known as sleeve gastrectomy - a fistula, which is an abnormal connection between two body parts. The main ways to treat this are through another operation, drainage, or endoscopy, a procedure using a long, flexible tube with a camera to look inside the body. The paper discusses different endoscopic treatment options including placement of a stent or clip, endoscopic vacuum therapy, endoscopic suturing, and injection of stem cells.

The paper also covers the rare problem of a gastric band, used in a different type of weight loss surgery, migrating or moving into the stomach. The authors suggest that endoscopic retrieval can be a non-invasive way to solve this problem. The paper reviews current scientific literature on these topics.

FAQs

  1. What are the treatment options for post-sleeve gastrectomy fistulas?
  2. What new endoscopic therapies are available for treating post-sleeve gastrectomy fistulas?
  3. What is the solution for intragastric gastric band migration after gastric band positioning?

Doctor’s Tip

A helpful tip a doctor might tell a patient about gastric sleeve surgery is to follow the post-operative instructions carefully to reduce the risk of complications such as fistulas. It is important to attend all follow-up appointments and communicate any symptoms or concerns with your healthcare provider promptly. Additionally, understanding the potential complications, such as gastric band migration, and being aware of the available endoscopic treatment options can help in case of any issues post-surgery.

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. It is important for patients to have tried other weight loss methods such as diet and exercise before considering gastric sleeve surgery. Additionally, patients should be committed to making lifestyle changes post-surgery to ensure long-term success.

Timeline

Before gastric sleeve surgery:

  • Patient undergoes a consultation with a bariatric surgeon to discuss the procedure and determine if they are a candidate for gastric sleeve surgery.
  • Patient undergoes pre-operative tests and evaluations to assess their overall health and readiness for surgery.
  • Patient may be required to follow a pre-operative diet and make lifestyle changes to prepare for the surgery.
  • Patient undergoes the gastric sleeve surgery, which typically takes 1-2 hours and involves removing a portion of the stomach to create a smaller, sleeve-shaped stomach.
  • Patient stays in the hospital for a few days after surgery for monitoring and recovery.

After gastric sleeve surgery:

  • Patient follows a strict post-operative diet and exercise regimen to promote weight loss and adjust to their new stomach size.
  • Patient may experience some pain, discomfort, and dietary restrictions in the immediate post-operative period.
  • Patient attends follow-up appointments with their bariatric surgeon to monitor their progress, address any complications, and make any necessary adjustments to their treatment plan.
  • Patient may experience significant weight loss over the following months and years, leading to improvements in overall health and quality of life.
  • Patient may need to make long-term lifestyle changes to maintain their weight loss and prevent complications.
  • Patient may experience improvements in obesity-related health conditions, such as diabetes, hypertension, and sleep apnea.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with gastric sleeve surgery?
  2. How will my diet and eating habits need to change after the surgery?
  3. What kind of follow-up care will be required after the surgery?
  4. How much weight can I expect to lose after gastric sleeve surgery?
  5. Are there any long-term effects or implications of gastric sleeve surgery that I should be aware of?
  6. What is the likelihood of developing complications such as fistulas or gastric band migration after the surgery?
  7. What are the available endoscopic treatment options for post-sleeve gastrectomy fistulas or gastric band migration?
  8. How effective are these endoscopic treatments in treating complications after gastric sleeve surgery?
  9. Are there any specific contraindications or factors that may affect the success of endoscopic treatment for post-sleeve gastrectomy complications?
  10. How often will I need to follow up with a gastroenterologist or endoscopist after undergoing gastric sleeve surgery?

Reference

Authors: Jung CFM, Binda C, Tuccillo L, Secco M, Gibiino G, Liverani E, Petraroli C, Coluccio C, Fabbri C. Journal: J Clin Med. 2024 Aug 18;13(16):4877. doi: 10.3390/jcm13164877. PMID: 39201020