Management of Leaks Post Sleeve Gastrectomy:

Mohd Yasser Alkayyal, MD, FRCSI, FACS, Mazen Taha, MD, Ayman Saleh, MD, Hamouda Alafari, MD, Fawaz C.torab, MD, PhD

Tawam Hospital in affiliation with Johns Hopkins Medicine, FMHS UAE university.

Background
Leak from the staple line is the most serious and life-threatening complication after Laparoscopic sleeve gastrectomy (LSG).

Aim:
The purpose of this paper is to analyze the outcome of the conservative management of leakage in a single center.

Patients and Methods
Between January 2009 and July 2012, eighteen patients were admitted to our center, endoscopic stenting in addition to systemic antibiotics, enteral feeding through naso-jujenal tube or parenteral feeding, and interventional drainage was used as a primary management in sixteen patients with confirmed leakage and contained intraperitoneal collection. A stent was diploid in other two patients who have persistent leakage after laparoscopic drainage of multiple collections and generalized sepsis. A positive outcome was considered as a complete closure of the leakage and resolution of the collection without the need for operative management.

Results
Leak was manifested with abdominal pain and fever between the 7th and 21st postoperative day. One patient has a one year history of gastro-bronchial fistula and in another patient, leak was confirmed later after multiple admissions for intraabdominal collections treated with interventional drainage. The most common leak location was at the gastroesophageal junction (seventeen cases, 94.4%). Leakage was confirmed as closed on gastrographin swallow in all sixteen patients with acute leakage (88.8%). Stent was removed after 3-4 weeks. The leak in the two patients with chronic fistulae has failed to close with the stent. On long term, Gastric bypass was performed in one patient due to severe stenosis distally to the leak site.

Conclusion
Non-operative management (percutaneous drainage with stent) is feasible, safe, and effective in treatment of acute staple line leaks after LSG, It can be a much better alternative to other surgical procedures such as total gastrectomy or conversion to RYGB with all the morbidities related to them, however in chronic leaks the role of stenting seems to be limited in treating this condition and surgical interventions is mandatory in most cases.

Session: Poster Presentation

Program Number: P426