Abstract
Background
Leaks after laparoscopic sleeve gastrectomy (LSG) are not very frequent but are a
difficult complication that can become chronic. Various treatment options have been
suggested but no definitive treatment regimen has been established. The aim of our
study is to report leak complications after LSG, their management, and outcomes.
Methods
Between June 2008 and October 2013, a total of 539 patients underwent laparoscopic
and robot-assisted laparoscopic sleeve gastrectomy at our institution. A retrospective
review of a prospectively collected database was performed for all LSG patients, noting
the outcomes and complications of the procedure.
Results
Fifteen (2.8%) patients presented with a leak after LSG. The diagnosis was made at
a mean of 27.2±29.9 days (range, 1–102) after LSG. Eight (53.3%) patients underwent
conservative treatment initially and 6 (75.0%) of these patients required stenting
as secondary treatment. Although leaks from 3 patients resolved with stenting, the
other 3 required restenting and 2 eventually underwent conversion to gastric bypass.
Five (33.3%) patients underwent endoscopic intervention, closing the leak with fibrin
glue (n = 3) or hemoclips (n = 2). Two (13.3%) patients who were diagnosed with a
leak immediately after LSG before discharge had their leak oversewn laparoscopically
with an omental patch. Leaks in 9 (60.0%) patients did not heal after the first intervention,
and the mean number of intervention required was 2.3±1.7 times (range, 1–7) for the
treatment of this condition.
Conclusion
Management of leaks after LSG can be challenging. Early diagnosis and treatment is
important in the management of a leak. However, it can be treated safely via various
management options depending on the time of diagnosis and size of the leak.
Keywords
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Article info
Publication history
Published online: July 10, 2014
Accepted:
July 6,
2014
Received:
March 26,
2014
Footnotes
☆Presented during the Poster Session at the 100th American College of Surgeons Annual Meeting, Washington, DC, Oct 6–10, 2013.
Identification
Copyright
© 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
