Management of Gastric Leaks After Laparoscopic Sleeve Gastrectomy

E Raga, F Sabench, M Vives, A Molina, M Hernandez, S Blanco, M Paris, A Sanchez, A Munoz, Daniel Del Castilo. Hospital Universitari Sant Joan de Reus. Universitat Rovira i Virgili

Introduction: Laparoscopic Sleeve gastrectomy (LSG) has gained prominence as a single option for their results in terms of weight loss and improvement of comorbidities. The leakage of the staple line is an important cause of morbidity and mortality. Its management depends on the severity and clinical presentation. Our goal is to identify factors that may predispose to the occurrence of postoperative leaks. Also, describe a diagnostic/therapeutic algorithm for its management, reviewing the cases occurred in our University Hospital.

Methods: A retrospective observational study of patients undergoing LSG from 2005 to 2012. 207 LSG were performed, using a bougie of 38 Fr. Distance from the pylorus of 5 cm. In all cases, reinforce of the suture line was used. Intraoperative leakage test with Blue methylene and an oral Barium study at 24 postoperative hours were performed in all patients.

Results: 8 patients of 207 had a gastric leak (3.8%). Mean age of 41.9 years and preoperative BMI 48.5 ± 4 kg/m2. 50% of patients with DM2 and 87.5 % with hypertension. 62.5 % (n=5) patients who had a gastric leak, had a previous surgical history of appendectomy or cholecystectomy. 37.5 % (n=3) leaks were detected by barium test, 12.5 % (n = 1) with upper digestive endoscopy and 50% (n=4) by CT scan. The presentation time was early (< 2nd day of surgery) in 62.5 % of patients (n=5). The therapeutic management was conservative by drainage in 6 patients. Two patients required reoperation: one had a sepsis and an exploratory laparoscopy was performed with placement of a new drain again. In another patient an endoscopic stent was placed at 11th postoperative day due to a late leak following to haemoperitoneum; No cases of mortality.

Conclusions: Gastric leak after LSG is a complication whose management should be based on clinical presentation and the diagnostic suspicion. The presence of comorbidities or previous surgery may be an important factor to take into account for this complication. The systematic placement of drainage allows treating conservatively most patients, reserving surgery when conservative measures have failed or when the patient has an acute abdomen or a sepsis.

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