Thoracic Esophageal Injury During LSG, Lessons Learnt and How I Manage It

Ayman M. Soliman, MBBCh, PhD, FACS

Product Details
Product ID: ACS-5486
Year Produced: 2018
Length: 7 min.


Esophageal perforation is a full-thickness injury to the esophagus that can occur during several situations, with the vast majority of injuries secondary to iatrogenic causes. Prior to the middle of the last century, esophageal perforation was a uniformly fatal entity. Advances in diagnosis, surgical therapy, antimicrobials, and intensive care now allow survival in the majority of cases diagnosed and treated in a timely manner. A 36-year-old adolescent female with past medical history of hyperlipidemia and arthritis was admitted to our hospital due to morbid obesity. Her Body Mass Index (BMI) was calculated to 42.1 kg/m2 (weight: 115 kg, height: 1.65 m). She decided to be treated with LSG. During the operation, the mobilization of the intra-abdominal part of the esophagus was easy and done as usual with blunt technique away from any thermal exposure and mobilization of about 5 cm to be intra-abdominal. After completion of the procedure and after injection of methylene blue and result was no apparent leak. However intraoperative thoracic esophageal perforation has been detected and surgically repaired. Conclusion: Use of endoscopy in calibration of stomach during Laparoscopic sleeve gastrectomy is safe associated with lower postoperative complications. The use of esophageal tubes during morbid obesity surgery should be done with extreme caution by the surgical team.