Alexander Aurora, MD, Leena Khaitan, MD, Alan Saber, MD. University Hospitals Case Medical Center
INTRODUCTION: Sleeve gastrectomy is becoming a more common procedure in the realm of bariatrics. Its success has been questioned by proponents who query its efficacy and risk of staple-line leak. Bariatric surgeons will appreciate the data compiled herein to better inform their patients of the risks and benefits.
METHODS: An electronic literature search of MEDLINE database plus manual reference checks of articles published on laparoscopic sleeve gastrectomy for morbid obesity and the risk of leak was complete. We analyzed 15 articles to provide a meta-analysis of the risk of leak after laparoscopic sleeve gastrectomy in morbid obesity. Three studies including 70 patients were revision patients.
RESULTS: Analsysis of 15 series covering 1021 patients revealed an average leak rate for laparoscopic sleeve gastrectomy of 2.8±2.6% (range 0-8%). Almost all groups used both green and blue load staplers (when documented). Only 3 studies (151 patients) used staple-line reinforcement. Six of 151 patients (3.5 ± 1.5%) using staple-line reinforcement developed leak. There were 20 of 870 patients (2.6 ± 2.9%) which developed leaks in which the staple-line was not reinforced. There was no significant difference between groups. Most leaks were discovered within 3 days of surgery, usually at the esophagogastric junction. More than 90% were managed non-operatively.
CONCLUSION: The average leak rate after laparoscopic sleeve gastrectomy is 2.8%. Most leaks can be managed conservatively. The use of staple-line reinforcement is not found to decrease stape-line leak.
Program Number: S045