Preprint Case Report Version 1 Preserved in Portico This version is not peer-reviewed

Piriform Fossa Injury during Calibration Tube Insertion in Laparoscopic Sleeve Gastrectomy

Taiki Nabekura
,
Takashi Oshiro
* ,
Kotaro Wakamatsu
ORCID logo ,
Natsumi Kitahara
,
Yuki Moriyama
,
Kengo Kadoya
,
Ayami Sato
,
Tomoaki Kitahara
,
Tasuku Urita
,
Yu Sato
ORCID logo ,
Masaru Tsuchiya
,
Shinich Okazumi
ORCID logo
Version 1 : Received: 19 April 2023 / Approved: 19 April 2023 / Online: 19 April 2023 (09:43:56 CEST)

A peer-reviewed article of this Preprint also exists.

Nabekura, T.; Oshiro, T.; Wakamatsu, K.; Kitahara, N.; Moriyama, Y.; Kadoya, K.; Sato, A.; Kitahara, T.; Urita, T.; Sato, Y.; Tsuchiya, M.; Okazumi, S. Piriform Fossa Injury during Calibration Tube Insertion in Laparoscopic Sleeve Gastrectomy. J. Clin. Med. 2023, 12, 3824. Nabekura, T.; Oshiro, T.; Wakamatsu, K.; Kitahara, N.; Moriyama, Y.; Kadoya, K.; Sato, A.; Kitahara, T.; Urita, T.; Sato, Y.; Tsuchiya, M.; Okazumi, S. Piriform Fossa Injury during Calibration Tube Insertion in Laparoscopic Sleeve Gastrectomy. J. Clin. Med. 2023, 12, 3824.

Abstract

Piriform fossa and/or esophageal injuries caused by calibration tubes are relatively rare and re-main unelucidated. Herein, we report the case of a 36-year-old woman with morbid obesity, sleep apnea, and menstrual abnormalities who was scheduled to undergo laparoscopic sleeve gastrectomy (LSG). We inserted a 36-Fr Nelaton catheter made of natural rubber as a calibration tube during the surgery. However, excessive resistance was observed. We confirmed a submuco-sal layer detachment of approximately 5 cm from the left piriform fossa to the esophagus using intraoperative endoscopy. Additionally, LSG was performed using an endoscope as the guiding calibration tube. We inserted a nasogastric tube under endoscopy with a guidewire before com-pleting the surgery, hoping for a guiding effect on saliva flow. After 17 months, the patient suc-cessfully lost weight postoperatively without complaints of neck pain or discomfort during swallowing. Therefore, if the damage is limited to the submucosal layer, as in this case, conserva-tive therapy should be considered, which is similar to the concept of not requiring suture closure in endoscopic submucosal dissection. This case highlights the risk of iatrogenic injuries to the pi-riform fossa and/or esophagus during LSG and the importance of careful calibration tube inser-tion to prevent them.

Keywords

laparoscopic sleeve gastrectomy; bariatric and metabolic surgery; complication; iatrogenic piriform fossa and esophageal injury; orogastric calibration tube

Subject

Medicine and Pharmacology, Surgery

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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