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Surgical Management Algorithm for Intrathoracic Sleeve Migration: A Retrospective Series and Literature Review
Karim Sabry1, Haitham Mostafa Elmaleh1, Seif Tarek El-Swaify2
1Division of Bariatric Surgery, Ain Shams University Hospitals, Cairo, Egypt.
Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
|September 8, 2022
Summary
Intrathoracic sleeve migration (ITSM) is a rare complication after laparoscopic sleeve gastrectomy (LSG). This study proposes a management algorithm based on diagnostic imaging and surgical findings, showing successful outcomes with various reconstructive procedures.
Area of Science:
- Bariatric Surgery
- Gastrointestinal Surgery
- Minimally Invasive Surgery
Background:
- Laparoscopic sleeve gastrectomy (LSG) is increasingly utilized for obesity management.
- Intrathoracic sleeve migration (ITSM) is an underreported but significant complication of LSG.
- Effective management strategies for ITSM are needed.
Purpose of the Study:
- To present a single center's experience with intrathoracic sleeve migration (ITSM) following laparoscopic sleeve gastrectomy (LSG).
- To conduct a comprehensive literature review on ITSM.
- To propose a surgical management algorithm for ITSM.
Main Methods:
- Retrospective chart review of 4000 LSG patients.
- Clinical suspicion based on refractory GERD/epigastric pain.
- Diagnosis confirmed by 3D-CT volumetry.
- Surgical management guided by CT, EGD, and diaphragmatic pillar assessment.
- Literature review of ITSM using multiple databases.
Main Results:
- Fifteen patients diagnosed with postoperative ITSM.
- Most common symptom: severe GERD unresponsive to medical treatment.
- Mean interval to diagnosis: 38.8 months.
- Treatments included re-sleeve gastrectomy, OAGB, and RYGB.
- No recurrent ITSM observed postoperatively.
- Literature review included 201 patients from 19 studies.
Conclusions:
- High index of suspicion is crucial for diagnosing ITSM.
- 3D-CT volumetry is a sensitive diagnostic tool for ITSM.
- Management strategy should be tailored to diagnostic workup and intraoperative findings, particularly the condition of the diaphragmatic pillars.
