1887
Volume 2020, Issue 2
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Background: Surgeons may encounter unexpected anatomical or pathological findings during various bariatric surgical procedures for which they must make prompt and critical decisions that had not been planned prior to the operation. In this practice review, we present our experiences with unexpected challenges and on-table decision making in bariatric surgery to share our knowledge with colleagues who may encounter the same challenges during bariatric surgery. This paper's content is of applied learning and practical value focusing on challenging intraoperative decision making; however, it does not discuss the details of the various techniques used during surgery.

Methods: This work is a single-center retrospective review of operations carried out on patients who had unexpected intraoperative findings during bariatric surgery despite the implementation of detailed preoperative evaluations that would have otherwise suggested standard procedures. These findings resulted in abandoned surgery or laparoscopic sleeve gastrectomy instead of the intended Roux-en-Y gastric bypass.

Results: A total of 449 patients had received various bariatric interventions in our unit between 2012 and 2016. Eleven patients, representing approximately 2.4% of the total number of patients surveyed had met the inclusion criteria and were added to the final list for analysis. The mean age of the included patients was 40.82 years (range: 30–51 years), and seven of the patients, representing approximately 63.6% of the included cases, were female. The mean body mass index of the 11 cases was 40.8 (range: 38–48). Only two cases (18.9%) had had their surgery abandoned; the rest (81.1%) had received laparoscopic sleeve gastrectomy instead of Roux-en-Y gastric bypass. None of the 11 patients had perioperative morbidity or mortality.

Conclusion: Intraoperative decision making for unexpected findings in bariatric surgery is challenging. In these circumstances, surgeons must make prompt and critical decisions, including abandoning the operation. The available literature on this subject is unsurprisingly limited because of the rarity of such findings.

Loading

Article metrics loading...

/content/journals/10.5339/qmj.2020.23
2020-09-28
2020-10-27
Loading full text...

Full text loading...

/deliver/fulltext/qmj/2020/2/qmj.2020.23.html?itemId=/content/journals/10.5339/qmj.2020.23&mimeType=html&fmt=ahah

References

  1. Flin R, Youngson G, Yule S. How do surgeons make intraoperative decisions? Qual Saf Health Care. 2007;16(3):235–239.
  2. Major P, Stefura T, Wale˛dziak M, Janik M, Pe˛dziwiatr M, Wysocki M, et al. What makes bariatric operations difficult-results of a national survey. Medicina (Kaunas). 2019;55(6).pii:E218.
  3. World Health Organization. Puska P, Nishida C, Porter D. Obesity and overweight. Global strategy on diet, physical activity and health. Available online from: https://www.who.int/dietphysicalactivity/media/en/gsfs_obesity.pdf [Accessed on 17.5.2020].
  4. Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon M, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;21(0 1):S1–27.
  5. De Simone B, Ansaloni L, Sartelli M, Kluger Y, Abu-Zidan FM, Biffl WL, et al. The operative management in bariatric acute abdomen (OBA) survey: long-term complications of bariatric surgery and the emergency surgeon's point of view. World J Emerg Surg. 2020;15(1):2.
  6. Langerman A, Siegler M, Angelos P. Intraoperative decision making: the decision to perform additional, unplanned procedures on anesthetized patients. J Am Coll Surg. 2016;222(5):956–960.
  7. Cristancho SM, Vanstone M, Lingard L, LeBel ME, Ott M. When surgeons face intraoperative challenges: a naturalistic model of surgical decision making. Am J Surg. 2013;205(2):156–162.
  8. National Institute for Health and Care Excellence. Obesity: identification, assessment and management. 27 November 2014. Available from: https://www.nice.org.uk/guidance/cg189/resources/obesity-identification-assessment-and-management-pdf-35109821097925 [Accessed on 24/8/2019].
  9. Zanotti D, Elkalaawy M, Hashemi M, Jenkinson A, Adamo M. Current status of preoperative oesophago-gastro-duodenoscopy (OGD) in bariatric NHS units-a BOMSS survey. Obes Surg. 2016;26(9):2257–2262.
  10. Fayers PM, Machin D. Sample size: how many patients are necessary? Br J Cancer. 1995;72(1):1–9.
  11. Khatua B, El-Kurdi B, Singh VP. Obesity and pancreatitis. Curr Opin Gastroenterol. 2017;33(5):374–ndash;382.
  12. Straatman J, Meester RJ, van Grieken NCT, de Graaf P, Kazemier G, Cuesta MA. Clinical picture: multiple sites of ectopic pancreatic tissue. Springerplus. 2015; 4:293.
  13. Haidar Ahmad H, Saliba C, Nicolas G, Ghandour MA, Zeaiter NM, Alzein H, et al. Unexpected gastric ectopic pancreas during sleeve gastrectomy: a case report. Am J Case Rep. 2019;20:1966–1968.
  14. Montalvo D, Hernandez P, Larrazabal A. Unexpected ectopic pancreatic tissue during laparoscopic bariatric surgery. Case report and literature review. Surg Obes Relat Dis. 2016;12(10):e87–e88.
  15. Raghavendra RS, Kini D. Benign, premalignant, and malignant lesions encountered in bariatric surgery. JSLS. 2012;16(3):360–372.
  16. Søreide K, Sandvik OM, Søreide JA, Giljaca V, Jureckova A, Bulusu VR. Global epidemiology of gastrointestinal stromal tumours (GIST): a systematic review of population-based cohort studies. Cancer Epidemiol. 2016;40:39–46.
  17. Jan A, Narwaria M, Mahawar KK. A systematic review of bariatric surgery in patients with liver cirrhosis. Obes Surg. 2015;25(8):1518–1526.
  18. Shimizu H, Phuong V, Maia M, Kroh M, Chand B, Schauer PR, et al. Bariatric surgery in patients with liver cirrhosis. Surg Obes Relat Dis. 2013;9(1):1–6.
  19. Mattar SG, Velcu LM, Rabinovitz M, Demetris AJ, Krasinskas AM, Barinas-Mitchell EM, et al. Surgically induced weight loss significantly improves nonalcoholic fatty liver disease and the metabolic syndrome. Ann Surg. 2005;242(4):610-617; discussion 618–620.
  20. Goh GB, Schauer PR, McCullough AJ. Considerations for bariatric surgery in patients with cirrhosis. World J Gastroenterol. 2018; 24(28):3112–3119.
  21. Cazzo E, Gestic MA, Utrini MP, Chaim FDM, Callejas-Neto F, Pareja JC, et al. Bariatric surgery in individuals with liver cirrhosis: a narrative review. Rev Assoc Med Bras. 2017;63(2):190–194.
  22. Childs JT, Esterman AJ, Thoris KA, Turner RC. Ultrasound in the assessment of hepatomegaly: a simple technique to determine an enlarged liver using reliable and valid measurements. Sonography. 2016;3:347–352.
  23. Hüttner FJ, Klotz R, Ulrich A, Büchler MW, Diener MK. Antecolic versus retrocolic reconstruction after partial pancreaticoduodenectomy. Cochrane Database Syst Rev. 2016; 2016(9):CD011862.
  24. Nicolas G, Kfoury T, Shimlati R, Koury E, Tohme M, Gharios E, et al. Diagnosis and treatment of small bowel strangulation due to congenital band: three cases of congenital band in adults lacking a history of trauma or surgery. Am J Case Rep. 2016;17:712–719.
  25. Chan DL, Talbot ML, Chen Z, Mo Kwon SC. Simultaneous ventral hernia repair in bariatric surgery. ANZ J Surg. 2014;84(7-8):581–583.
  26. Zhao K, Liu J, Wang M, Yang H, Wu A. Safety and efficacy of laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass: a systematic review and meta-analysis. J Eval Clin Pract. 2020;26(1):290–298.
  27. Joo P, Guilbert L, Sepúlveda EM, Ortíz CJ, Donatini G, Zerrweck C. Unexpected intraoperative findings, situations, and complications in bariatric surgery. Obes surg. 2019;29(4):1281–1286.
  28. Hackshaw A. Small studies: strengths and limitations. Eur Respir J. 2008;32:1141–1143.
  29. Langham A. A practical guide to sampling. Available online from: https://www.nao.org.uk/wp-content/uploads/2001/06/SamplingGuide.pdf [Accessed on 20.5.2020].
  30. Al Saady R, Ejeckam G. Histopathological findings in laparoscopic sleeve gastrectomy specimens. QMJ. 2019;2019(1):5.
http://instance.metastore.ingenta.com/content/journals/10.5339/qmj.2020.23
Loading
/content/journals/10.5339/qmj.2020.23
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error