Luciano J Deluca, MD, Liliana B Parasporo, Patricio J Cal, MD, Tomas C Jakob, MD, Ezequiel O Fernandez, MD. Centro de Rehabilitacion Quirurgica de la Obesidad (CRQO)
INTRODUCTION: Laparoscopic sleeve gastrectomy is the most commonly performed restrictive bariatric procedure worldwide. Increasing evidence supports its good results in both weight loss and resolution or improvement of comorbidities . The most feared complication of this technique is the leak in the upper third of the suture line, near the gastroesophageal junction (GEJ) because of its difficult management. The frequency of this complication varies between 0-20% depending on the series. The objective of this study is to describe the management of gastric leaks in a high surgical volume centre.
METHODS AND PROCEDURES: This is a descriptive cross sectional study. Thirty-five patients with gastric leaks after sleeve gastrectomy from a total of 3420 patients operated between January 2007 and April 2016 were evaluated. All patients had a drain placed during surgery. The need for additional procedures such as percutaneous drainage or surgery were evaluated, as well as type of feeding, need for stents and total time to complete resolution.
RESULTS: Out of the 35 patients, 15 were managed with primary surgery drainage (42.85%), without additional procedures. 12 required a percutaneous drainage (34.28%) and in 3 of them a covered stent was placed. Seven patients (20%) required laparoscopic drainage. One patient (2.85%) with gastro pleural fistula was resolved by thoracoscopy and stent placement. Eleven patients (31.4%) were handled as outpatients throughout the whole process. The remaining patients required a median of 4 days hospital stay after readmission. Parenteral nutrition was necessary in 5 patients, and enteral feeding in 3. 30-day mortality was 0% and 90-day mortality 5.7 %. The time to final resolution ranged between 25 and 426 days, with a median of 40 days.
CONCLUSIONS: Most patients were handled with minimally invasive procedures (surgical drainage or percutaneous drainage) and oral diet. 31.4% required no readmission and were treated as outpatients. Mortality related to leaks remains high.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80562
Program Number: P534
Presentation Session: Poster (Non CME)
Presentation Type: Poster
