Laparoscopic Conversion of Sleeve Gastrectomy to Roux-En-Y Gastric Bypass for Chronic Leak.

E Lo Menzo, MD, PhD

Cleveland Clinic Florida

Introduction: LSG is an accepted procedure performed worldwide. The proper management of various surgical complications is still under debate. We present a case of chronic leak after sleeve gastrectomy that required conversion to RYGB.

Materials and Methods: A 40 year old female underwent a sleeve gastrectomy for morbid obesity. Post-operatively the patient developed persistent pain, nausea, and vomiting. UGI showed a stricture in the middle of the sleeve, but no leak was seen. Treatments included dilatations, stent placement, and TPN, however no improvement was seen.
She underwent a laparoscopic conversion to a RYGB. Intraoperative findings showed chronic leak penetrating posteriorly into the pancreas. The sleeve was dissected of the liver and off of the pancreas. The middle and proximal portion of the sleeve was resected using linear staple. An esophagojejunostomy was created using a side-to-side linear staple technique.

Result: The recovery of the patient was uneventful, with a normal UGI on post operative day one without leak or obstruction.

Conclusion: The optimal management of leaks after sleeve gastrectomy is still under debate. The different techniques being used include stents, t-tube insertion, oversewing the defect, and some suggest using bioglue. The ability to convert a sleeve gastrectomy to a roux-en-y gastric bypass appears to be a safe option for the treatment of chronic leaks.

Key Words: Laparoscopic Sleeve Gastrectomy, Leak, Revision

Session: Video Channel Day 1

Program Number: V048