Prevention of Postoperative Sleeve Gastrectomy Leaks Using a Medial to Lateral Technique and Pyloric Botox Injection

Aram E Jawed, MD, Amir H Moazzez, MD, FACS, FASMBS. INOVA Bariatric Surgery, INOVA Fair Oaks Hospital

In order to mitigate the dreadful complication of a sleeve gastrectomy leak we have altered the classic dissection to performing a medial to lateral technique whereby significantly decreasing the risk of devascularization and thermal injury to the proximal stomach near the gastroesophageal junction as referenced by the literature as the most common area for leak.  In addition, we perform a chemical pyloroplasty using botulism toxin to decrease intragastric pressure and allow for easier gastric emptying to further attenuate our leak risk.  Having used these methods depicted in the video since January 2014, (approximately 250 cases) our leak rate is 0%.

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