David C Kelly, MD, MHA, MS, Salim Abunnaja, MD, Lawrence Tabone, MD, John Nasr, MD, Nova Szoka, MD. West Virginia University
Leak following laparoscopic sleeve gastrectomy is a common complication with incidence rates of 0.5-2.2%. Most leaks resolve quickly with conservative measures but some may persist for weeks to months. Management of persistent and chronic leaks after sleeve gastrectomy can be a difficult management problem. The Galvao Neto group has proposed a management algorithm based on the length of time that the leak is present.
This video case report demonstrates an endoscopic septotomy performed for a chronic sleeve leak. A 52 year old female with a history of morbid obesity underwent a laparoscopic sleeve gastrectomy at an outside facility. The patient developed a leak and had drains placed laparoscopically. The patient was then transferred to our facility on POD#21 for persistent purulence from the drains. We then proceeded down the management algorithm with stenting. The leak persisted and stenting with dilation was performed. With continued leak, we then progressed to an endoscopic septotomy with dilation. After septotomy and dilation, the patient then clinically improved and the leak healed.
The algorithm proposed by the Galvao Neto group is a reasonable and effective method of managing sleeve gastrectomy leaks, it includes septotomy and dilation for chronic sleeve leaks.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95262
Program Number: V046
Presentation Session: Bariatric I – Complications
Presentation Type: Video