Assessing Bleeding Risk in Bariatric Surgeries: A Retrospective Analysis Study

<b><i>Objective:</i></b> To determine the factors that influence bleeding during the course of bariatric surgeries. <b><i>Background:</i></b> Bariatric surgery is safe with a low percentage of complications compared with other abdominal surgeries. Bleeding is one of the most common complications in surgery for obesity that has the risk of being catastrophic. <b><i>Methods:</i></b> The study includes 8,544 cases that underwent bariatric surgery from January 2013 to March 2016 retrospectively, in 4 private institutions. Multiple demographic data were collected: patient characteristics, diseases, medications, surgery type, operative technique, devices, surgeon’s skill, and volume.<b><i> Results:</i></b> Bleeding was the most frequent complication that occurred in 122 (1.3%) patients. The Gastric bypass had the highest rate of bleeding (3.05%) of which, 20% were intraoperative bleeding and 80% postoperatively (intra-abdominal in 75%, and intra-luminal in 5%). Simultaneous surgeries, revisional surgeries, stratification of body mass index, stapler line reinforcement, and hospital volume did not affect bleeding occurrence. The determining factors for bleeding were hypertension, chronic lung disease, age &#x3e;45 years, arrhythmia, and surgeon’s skills. <b><i>Conclusion:</i></b> Bleeding after bariatric surgery has a low occurrence. The factors that influence the occurrence of perioperative bleeding in bariatric surgery are: hypertension, chronic lung disease, age &#x3e;45 years, arrhythmia, and surgeon’s skills.

Plasma presepsin in determining gastric leaks following bariatric surgery

Background To be able to prevent morbid obesity in the long-term, laparoscopic sleeve gastrectomy (LSG) is one of the most effective surgical interventions. However, leakage and bleeding from the stapler line are significant complications. The aim of this study was to determine the role of the levels of plasma presepsin in the detection of stapler leakage. Materials and methods The study included 300 patients with LSG due to morbid obesity and 40 control subjects. Before any medical treatment was applied, blood samples were taken from patients at 12 h preoperatively and on days 1, 3, and 5 postoperatively. Evaluation was made of plasma presepsin levels, white blood count (WBC), C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR), in all patients with sleeve gastrectomy line leakage. Results The WBC, CRP, NLR and presepsin values measured on days 1, 3 and 5 postoperatively were determined to be higher in patients with leakage compared to those without. The predictive value of presepsin (p = 0.001), CRP (p = 0.001) and NLR (p = 0.001) was determined to be statistically significantly higher than that of WBC (p = 0.01). Conclusion The results of the study suggest that presepsin levels could have a role in the detection and follow-up of stapler line leaks after LSG. Elevated presepsin levels, on postoperative day 1 in particular, could have a key role in the early detection of possible complications which are not seen clinically.

Management of sleeve gastrectomy leakage with endoscopic stenting

Background: Sleeve gastrectomy is one of the most commonly applied procedures for obesity surgery. Leakage from the stapler line and bleeding are the most important complications of sleeve gastrectomy. This study aimed to report the results of esophageal stent procedure applied to cases who developed leaks after sleeve gastrectomy.Methods: This study included patients who had sleeve gastrectomy due to morbid obesity and were detected to have a leak after the procedure. Demographic features, time of leakage after the surgery, and the management of the leak were analyzed.Results: it was detected in this study, 1220 cases who had sleeve gastrectomy for morbid obesity. Leaks were developed in 10 patients after Laparoscopic Sleeve Gastrectomy (LSG). Four patients, followed conservatively without stent application, were excluded. Six patients, treated with stent application, were included. Two of the patients were males, and four were females (M/F=1/2). The mean age was 38.3 (±11.57) (range: 26-58). The mean body mass index was 43.26 (±2.10)kg/m2. The incidence of a leak was 0.81%.Conclusions: In a conclusion, stents can be safely applied by experienced endoscopists for the management of sleeve gastrectomy leakage.