With the growing incidence of morbid obesity worldwide and laparoscopic sleeve gastrectomy as the most common bariatric procedure performed worldwide for a decade now, it is estimated that well over 1 million sleeves have been performed since its inception [
]. Despite sleeve leak rates having decreased nearly 10-fold to a low prevalence of .1%, they remain the most common, serious, and challenging complication and translate to more than 1000 leaks that have been managed [
- Clapp B.
- Ponce J.
- DeMaria E.
- et al.
American Society for Metabolic and Bariatric Surgery 2020 estimate of metabolic and bariatric procedures performed in the United States.
Surg Obes Relat Dis. 2022; 18: 1134-1140
]. First-line management has included endoscopic techniques such as stenting, drainage, and clipping, or a combination thereof [
- Nedelcu M.
- Danan M.
- Noel P.
- Gagner M.
- Nedelcu A.
- Carandina S.
Surgical management for chronic leak following sleeve gastrectomy: review of literature.
Surg Obes Relat Dis. 2019; 15: 1844-1849
]. For those that fail endoscopic interventions, described surgical techniques include Roux-en-Y gastric bypass (RYGB), fistula-jejunostomy, and esophagojejunostomy (EJ) with leak rates of 38%, 22%, and 8%, respectively. High leak rates as a consequence of treating a leak are particularly disheartening and beg the question of whether a better approach can be found.
- Nedelcu M.
- Manos T.
- Cotirlet A.
- Noel P.
- Gagner M.
Outcome of leaks after sleeve gastrectomy based on a new algorithm addressing leak size and gastric stenosis.
Obes Surg. 2015; 25: 559-563
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- American Society for Metabolic and Bariatric Surgery 2020 estimate of metabolic and bariatric procedures performed in the United States.Surg Obes Relat Dis. 2022; 18: 1134-1140
- Surgical management for chronic leak following sleeve gastrectomy: review of literature.Surg Obes Relat Dis. 2019; 15: 1844-1849
- Outcome of leaks after sleeve gastrectomy based on a new algorithm addressing leak size and gastric stenosis.Obes Surg. 2015; 25: 559-563
Lainas P, Triantafyllou E, Ben Amor V, et al. Laparoscopic Roux-en-Y fistulojejunostomy as a salvage procedure in patients with chronic gastric leak after sleeve gastrectomy. Surg Obes Relat Dis. Epub 2022 Dec 10.
- Roux-en-Y fistulo-jejunostomy as a salvage procedure in patients with post-sleeve gastrectomy fistula: mid-term results.Surg Endosc. 2016; 30: 4200-4204
- Assessment of quality of life after gastrectomy using EORTC QLQ-C30 and STO22.World J Surg. 2011; 35: 357-364
Published online: February 11, 2023
Publication stageIn Press Journal Pre-Proof
Published by Elsevier Inc. on behalf of American Society for Metabolic and Bariatric Surgery.
ScienceDirectAccess this article on ScienceDirect
- Laparoscopic Roux-en-Y fistulojejunostomy as a salvage procedure in patients with chronic gastric leak after sleeve gastrectomySurgery for Obesity and Related Diseases