Stapling and Section of the Nasogastric Tube during Sleeve Gastrectomy: How to Prevent and Recover?

Abstract

Bariatric surgery has become an integral part of morbid obesity treatment with well-defined indications. Some complications, specific or not, due to laparoscopic sleeve gastrectomy (LSG) procedure have recently been described. We report a rare complication unpublished to date: a nasogastric section during great gastric curve stapling. A 44-year-old woman suffered of severe obesity (BMI 36.6 kg/m2) with failure of medical treatments for years. According to already published technique, a LSG was performed. Six hours postoperatively, a nurse removed the nasogastric tube according to the local protocol and the nasogastric tube was abnormally short, with staples at its extremity. Surgery was performed with peroperative endoscopy. In conclusion, this is the first publication of a nasogastric section during LSG. Therefore we report this case and propose a solution to prevent its occurrence. To avoid this kind of accident, we now systematically insert the nasogastric tube by mouth through a Guedel cannula. Then, to insert the calibrating bougie, we entirely withdraw the nasogastric tube.

Keywords: Complication; Nasogastric tube; Sleeve gastrectomy.

Figures

Fig. 1

In the recovery room, the nurse observes that the nasogastric tube was shorter, with staples fixed on its extremity (⋆).

Fig. 2

Tomographic imaging with 3D reconstruction. The remnant nasogastric fragment (⋆) is located in the antrum, and the abdominal drain (Δ) against the gastric staple line.

Fig. 3

Endoscopic extraction of the remnant nasogastric tube. The remnant fragment of the nasogastric tube (⋆) is localised endoscopically and extracted with an endoscopic loop (Δ). This approach is completed by the surgeon, who performs laparoscopic suturing of the staple line defect.