Successful management of staples line leaks after sleeve gastrectomy

Matthew Benenati1, Michael De France2, Rahul Sharma2, Lou Balsama, DO3. 1Anne Arundel Medical Center, 2Rowan University, 3Kennedy University Hospital

Introduction: Laparoscopic sleeve gastrectomy (LSG) is a standalone procedure which is gaining broad acceptance in the field of bariatric surgery, where it has been shown to be effective in weight loss and the reduction of obesity related comorbid conditions. A staple line leak (SLL) post-LSG is one of the most serious complications associated with the procedure. The aim of this study was to examine post-LSG rates and characteristics using a retrospective cohort analysis at a single community-based Bariatric Center of Excellence.

Methods: Three hundred eighty two patients who underwent bariatric surgery between January 2007 and June 2014 and experienced any sort of post-surgical complication were identified. Of these, 12 cases were identified as having developed SSLs. Data collected from hospital records and outpatient records for both surgical and gastroenterology offices included patient demographics, operative, and post-operative characteristics. The day of diagnosis of SSL was determined by the first study or procedure that identified the leak. Resolution was determined by the removal of a stent or catheter or resolution of clinical signs and symptoms.

Results: The patients experiencing SLL post-LSG had a mean age of 46.25 (range 19-66) and mean BMI of 46.3. Post-operative timing of leaks had a mean of 21 days and a median of 15 days (range 1-57). CT scans had a 100% sensitivity in showing evidence of an SLL while upper GI series showed a sensitivity of 50%. Mean time from diagnosis to treatment of SLL was 1.8 days. Patients required 42.4 days between diagnosis and resolution of the complication (range 5-90). Patients with a follow-up interval of 12 months +/- 1 month (n=7) showed an average weight loss of 72%.

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Conclusions: SLL is a feared complication post-LSG. While a great deal of attention has been paid to complication rates, less data is available on the timeframes for diagnosis and treatment as well as the long term consequences on weight loss. Based on this study, patients may be counseled that in the event of a SLL, the average lengthening of treatment is 42 days, and that they can expect to still attain their goal weight loss.

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