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2026, Number 1-2

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Rev Mex Cir Endoscop 2026; 27 (1-2)

Inadvertent stapling of the orogastric tube in laparoscopic sleeve gastrectomy. Clinical case

Guzmán-Esquivel H, Arenas-Padilla JA, Pérez-Basurto MS

Language: Spanish
References: 39
Page: 39-43
PDF size: 877.29 Kb.


ABSTRACT

Introduction: laparoscopic sleeve gastrectomy is the most common bariatric procedure worldwide. However, unusual events such as accidental stapling of intraluminal devices can occur and are underreported in the literature. Although rare, these complications carry a high risk of gastric leakage and require specialized interventions to prevent signifi cant morbidity. Clinical case: a 40-year-old male patient with morbid obesity (BMI 40.1) and type 2 diabetes mellitus underwent laparoscopic sleeve gastrectomy. During gastric stapling with a 39 Fr calibration bougie, accidental stapling of the bougie in the gastric fundus was identified. The affected segment was resected, airtightness was confirmed by endoscopy, and reinforcement with sutures was performed. The initial postoperative course was favorable; however, the patient was readmitted due to abdominal pain and tachycardia. A CT scan revealed a left subphrenic collection. He was managed conservatively with fasting, antibiotics, and enteral nutrition. At 20 months follow-up, the patient showed satisfactory progress with 32% weight loss. Conclusion: accidental stapling of the bougie is a rare but serious complication. Early detection and prompt surgical treatment, combined with comprehensive postoperative management, are essential to prevent major sequelae and ensure favorable clinical outcomes.


REFERENCES

  1. Belluzzi A, Sample JW, Marrero K et al. Rare complicationsfollowing laparoscopic sleeve gastrectomy. J Clin Med. 2024; 13: 4456.

  2. Baltasar A, Bou R, Serra C, Pérez N, Ros A. Stapling thebougie in sleeve gastrectomy: video. Surg Obes Relat Dis.2016; 12: 1136-1138.

  3. Abu-Gazala S, Donchin Y, Keidar A. Nasogastric tube,temperature probe, and bougie stapling during bariatricsurgery: a multicenter survey. Surg Obes Relat Dis. 2012; 8:595-600; discussion 600-1.

  4. Mohamedahmed AYY, Hamid M, Zaman S et al. Doesomentopexy make a difference in laparoscopic sleevegastrectomy for obesity treatment? a systematic review andmeta-analysis. Obes Surg. 2024; 34: 218-235.

  5. Achi N, Wang H, Hao J, Chen W. Innovative approachesto managing postoperative complications in laparoscopicsleeve gastrectomy: a scoping review. J Laparoendosc AdvSurg Tech A. 2025; 35: 6-14.

  6. Meshikhes AW, Al-Saif OH. Iatrogenic oesophagealtransection during laparoscopic sleeve gastrectomy. BMJCase Rep. 2014; 2014: bcr2013201260.

  7. Péquignot A, Dhahria A, Mensah E et al. Stapling andsection of the nasogastric tube during sleeve gastrectomy:how to prevent and recover? Case Rep Gastroenterol. 2011;5: 350-354.

  8. Gaillard M, Lainas P, Agostini H et al. Impact of thecalibration bougie diametre during laparoscopic sleevegastrectomy on the rate of postoperative staple-line leak(BOUST): study protocol for a multicentre randomizedprospective trial. Trials. 2021; 22: 806.

  9. Palermo M, Serra E. Laparoscopic sleeve gastrectomy: howdo I do it. J Laparoendosc Adv Surg Tech A. 2020; 30: 2-5.

  10. Gagner M, Huang RY. Comparison between orogastrictube/bougie and a suction calibration system for effectson operative duration, staple-line corkscrewing, andesophageal perforation during laparoscopic sleevegastrectomy. Surg Endosc. 2016; 30: 1648-1655.

  11. Sakran N, Raziel A, Gralnek IM et al. Low incidence ofpostoperative leaks when using small-diameter calibratedbougies during laparoscopic sleeve gastrectomy: aretrospective cohort study. World J Surg. 2020; 44: 849-854.

  12. Chang PC, Chen KH, Jhou HJ et al. Promising effects of33 to 36 Fr. bougie calibration for laparoscopic sleevegastrectomy: a systematic review and network metaanalysis.Sci Rep. 2021; 11: 15217.

  13. Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy andthe risk of leak: a systematic analysis of 4,888 patients. SurgEndosc. 2012; 26: 1509-1515.

  14. Omarov N, Huseynov E, Coban G, Hasanov M.Is Laparoscopic sleeve gastrectomy without staplereinforcement safer? analysis of 426 consecutive cases. AnnItal Chir. 2025; 96: 562-567.

  15. Shekh ZA, Roqaia AH. Sleeve gastrectomy without bougieis safe and effective operation: case report. J Surg Case Rep.2020; 2020(6): rjaa183.

  16. Sharma N, Chau WY. Remodifying omentopexy techniqueused with laparoscopic sleeve gastrectomy: does it changeany outcomes? Obes Surg. 2020; 30: 1527-1535.

  17. Sánchez BS, Safadi BY, Kieran JA et al. Orogastric tubecomplications in laparoscopic Roux-en-Y gastric bypass.Obes Surg. 2006; 16: 443-447.

  18. Global tuberculosis report 2023. Who.int. World HealthOrganization; 2023. Disponible en: https://www.who.int/publications/i/item/9789240083851

  19. Myers-Esmenjaud JA, Hernández-Márquez JM, Pimentel-Mestre HL, Mendoza-Gómez A, López-Olmos PA, Olvera-Vidal M et al. Tuberculosis intestinal, una entidad pocofrecuente de abdomen agudo. Acta Med. 2022; 20: 67-70.doi: 10.35366/103559.

  20. Gil-Rojas N, Cerda-Galomo CA, Carrillo-Muñoz A, Salas-Gordillo F, Alexanderson-Rosas EG, Serralde-Zúñiga AE etal. Tuberculosis gastrointestinal diagnosticada por autopsiaen el Hospital General de México. Rev Med Hosp Gen Méx.2014; 77: 64-69.

  21. Maulahela H, Simadibrata M, Nelwan EJ, Rahadiani N,Renesteen E, Suwarti SWT et al. Recent advances in thediagnosis of intestinal tuberculosis. BMC Gastroenterol.2022; 22: 89. doi: 10.1186/s12876-022-02171-7.

  22. Suárez-Noya A, González-Bernardo O, Riera-Velasco JR,Suárez A. Tuberculosis intestinal como simuladora de unaneoplasia de colon. Rev Gastroenterol Mex. 2023; 88: 184-186. doi: 10.1016/j.rgmx.2022.06.005.

  23. Gan H, Mely M, Zhao J, Zhu L. An analysis of theclinical, endoscopic, and pathologic features ofintestinal tuberculosis. J Clin Gastroenterol. 2016; 50:470-475.

  24. Tanoglu A, Erdem H, Friedland JS, Almajid FM, BatirelA, Kulzhanova S et al. Clinicopathological profile ofgastrointestinal tuberculosis: a multinational ID-IRI study.Eur J Clin Microbiol Infect Dis. 2020; 39: 493-500. doi:10.1007/s10096-019-03749-y.

  25. Cheng VC, Yam WC, Hung IF, Woo PC, Lau SK, Tang BS etal. Clinical evaluation of the polymerase chain reaction forthe rapid diagnosis of tuberculosis. J Clin Pathol. 2004; 57:281-285. doi: 10.1136/jcp.2003.012658.

  26. Clarridge JE 3rd, Shawar RM, Shinnick TM, PlikaytisBB. Large-scale use of polymerase chain reaction fordetection of Mycobacterium tuberculosis in a routinemycobacteriology laboratory. J Clin Microbiol. 1993; 31:2049-2056. doi: 10.1128/jcm.31.8.2049-2056.1993.

  27. Kolk AH, Kox LF, van Leeuwen J, Kuijper S, Jansen HM.Clinical utility of the polymerase chain reaction in thediagnosis of extrapulmonary tuberculosis. Eur Respir J. 1998;

  28. 11: 1222-1226. doi: 10.1183/09031936.98.11061222.11. Watermeyer G, Katsidzira L, Setshedi M, Devani S,Mudombi W, Kassianides C et al. Inflammatory boweldisease in sub-Saharan Africa: epidemiology, risk factors,and challenges in diagnosis. Lancet Gastroenterol Hepatol.2022; 7: 952-961. doi: 10.1016/S2468-1253(22)00047-4.

  29. Kedia S, Das P, Madhusudhan KS, Dattagupta S, Sharma R,Sahni P et al. Differentiating Crohn’s disease from intestinaltuberculosis. World J Gastroenterol. 2019; 25: 418-432.doi: 10.3748/wjg.v25.i4.418.

  30. Addissouky TA. Transforming intestinal tuberculosismanagement: advances in diagnostics, therapeutics, andprevention. J Rare Dis (Berlin). 2025; 4. doi: 10.1007/s44162-025-00090-1.

  31. Trajman A, Campbell JR, Kunor T, Ruslami R, Amanullah F,Behr MA et al. Tuberculosis. Lancet. 2025; 405: 850-866.doi: 10.1016/S0140-6736(24)02479-6.

  32. Horsburgh CR Jr, Barry CE 3rd, Lange C. Treatment oftuberculosis. N Engl J Med. 2015; 373: 2149-2160. doi:10.1056/NEJMra1413919.

  33. Nahid P, Dorman SE, Alipanah N, Barry PM, Brozek JL,Cattamanchi A et al. Official American Thoracic Society/Centers for Disease Control and Prevention/InfectiousDiseases Society of America Clinical Practice Guidelines:treatment of drug-susceptible tuberculosis. Clin Infect Dis.2016; 63: e147-e195. doi: 10.1093/cid/ciw376.

  34. Chatterjee A, Jha DK, Sekar A, Sharma V. Mistakes toavoid in the management of abdominal tuberculosis.Expert Rev Anti Infect Ther. 2025; 23: 197-215. doi:10.1080/14787210.2025.2468331.

  35. Aljarallah BM. Clinical study of intestinal tuberculosis and itsresponse to short course anti-tuberculosis therapy. J Pioneer MedSci. 2025; 14: 456-463. doi: 10.47310/jpms202514s0160.

  36. Jha DK, Pathiyil MM, Sharma V. Evidence-based approachto diagnosis and management of abdominal tuberculosis.Indian J Gastroenterol. 2023; 42: 17-31. doi: 10.1007/s12664-023-01343-x.

  37. Urakawa S, Nishi H, Yoshimura D, Sakata K, Ikeda K,Hashimoto S et al. Clinical factors associated with surgicalinterventions in patients with intestinal obstruction causedby abdominal tuberculosis. Surg Today. 2025; 55: 1896-1903. doi: 10.1007/s00595-025-03098-8.

  38. Thioluna ME, Purwanta RS. Successful management ofcomplex intestinal tuberculosis with ileal perforation: a casereport. BioSci Med J Biomed Transl Res. 2024; 8: 5582-5592. doi: 10.37275/bsm.v8i12.1136.

  39. Namasivayam S, Maiga M, Yuan W, Thovarai V, CostaDL, Mittereder LR et al. Longitudinal profiling reveals apersistent intestinal dysbiosis triggered by conventionalanti-tuberculosis therapy. Microbiome. 2017; 5: 71. doi:10.1186/s40168-017-0286-2.




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