الفهرس 
OBESITY AND BARIATRIC SURGERIESOnly 14 pages are availabe for public view
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Abstract
Abstract
Treatment often depends on the clinical situation present. If the leak is well contained and the patient is haemodynamically stable, the patient can be treated conservatively with nothing per mouth percutaneous drainage, intravenous antibiotics, and intravenous nutrition. If the leak is not well contained and the patient is haemodynamically stable, laparoscopic exploration or stent via endoscope or intervention radiology is warranted. If the patient is haemodynamically compromised, open exploration should be performed. During exploration, whether open or laparoscopic, there are 3 principles that must be addressed at the time of exploration: repair of the leak, drain placement, and placement of gastrostomy tube in bypassed stomach.
There are important measures to decrease the incidence of leakage, surgeon preparation is an important key to success with this challenging, advanced laparoscopic procedure. The surgeon must be familiar with management of a bariatric patient, including appropriate indications for surgery, preoperative evaluation, perioperative management, and long term follow up care. Advanced laparoscopic skills, including two handed technique and laparoscopic stapling and suturing, are required. Both fundamentals of bariatric surgery and advanced laparoscopic surgery should be mastered before performing laparoscopic surgery, several intraoperative techniques have been implanted to prevent the anastomosis leak. These interventions include intraoperative pneumatic testing, the use of linear staplers with shorter stapler height, oversewing of staple line, use of omental wrap, and measures designed to reinforce staple line, such as fibrin glue, peristrips, seamguard, bovine pericardium and various other staple line reinforcement material.
Keywords: Laparoscopic Sleeve Gastrectomy- Mini gastric bypass- Obstructive sleep anea Self expanded metalic stent- Staple line reinforcement