Endoscopic management of esophageal perforation caused by calibrating bougie during laparoscopic sleeve gastrectomy

Abstract

Background: Laparoscopic Sleeve Gastrectomy (LSG) is one of the most used surgical techniques for the treatment of morbid obesity. The esophageal perforation (EP) secondary to the use of calibrating bougie is a rare complication.
Case presentation: A 43-year-old woman with a body mass index (BMI) of 54 kg/m2 underwent LSG. During the use of a calibrating bougie, a distal EP occurred, but it became evident only during the second day after the surgery. The patient was hospitalized in Intensive Care Unit because of respiratory failure and her clinical conditions did not permit a safe surgical treatment. The EP was treated successfully by endoscopic conservative approach with a double-covered self-expanding endoprosthesis (SEMS).
Results: The esophageal calibrating bougie, often placed by an anaesthesiologist, is undoubtedly useful during the learning curve of the surgeon to ensure a correct sleeve size; however, it may result in severe and difficult-to-treat iatrogenic lesions.
Conclusions: Managing the complications through conservative endoscopy is possible, but in order to support these patients, the immediate availability of an intensive care unit is essential. We underline the importance of a dedicated team of surgeons and anaesthesiologists and a multidisciplinary team to treat major complications in bariatric surgery.