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Not All Leaks Are Created Equal: a Comparison Between Leaks After Sleeve Gastrectomy and Roux-En-Y Gastric Bypass

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Abstract

Introduction

It is commonly stated in bariatric surgical forums that leaks following laparoscopic sleeve gastrectomy (LSG) are more difficult to manage than those following laparoscopic roux-en-Y gastric bypass (LRYGB). However, no previous study has provided a thorough comparison of leak management following these two operations.

Methods

Our database was retrospectively reviewed to identify patients with leak following LSG and LRYGB performed between January 2007 and December 2017.

Results

Postoperative leak was diagnosed in 16/2132 (0.75%) LSG and 9/595 (1.5%) LRYGB patients. More of the LRYGB leaks had undergone revisional surgeries (66.7 vs. 6.3%, p < 0.001), and were diagnosed in the index admission (77.8 vs. 18.7%, p = 0.002). The mean time between the bariatric operation and the diagnosis of leak was 6.0 days in LRYGB and 26.2 days in LSG patients (p = 0.097). Approximately two thirds of each group were initially treated with laparoscopic exploration and drainage. Subsequent endoscopy was utilized more commonly in LSG patients (87.5 vs. 22.2%, p < 0.001). Drainage alone (laparoscopic or percutaneous) eventually led to leak resolution in more LRYGB patients (66.7 vs. 18.8%, p = 0.02), while endoscopic intervention led to resolution in more LSG patients (37.5 vs. 0%, p = 0.04). The mean time between leak diagnosis and its resolution was 57.8 and 44.2 days, for LSG and LRYGB patients, respectively.

Conclusion

The diagnosis of leak tends to be earlier in LRYGB patients. Endoscopic therapies are more frequently required in the management of leaks following LSG, while in those following LRYGB, drainage alone leads to resolution of leak in the majority of cases.

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Authors and Affiliations

  1. Department of Surgery, Hadassah-Hebrew University Medical Center, Mount Scopus, 91240, Jerusalem, Israel

    Abbas Al-Kurd, Ronit Grinbaum, Ala’a Abubeih, Ariel Verbner, Amram Kupietzky, Ido Mizrahi, Haggi Mazeh & Nahum Beglaibter

Authors
  1. Abbas Al-Kurd
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  2. Ronit Grinbaum
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  3. Ala’a Abubeih
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  4. Ariel Verbner
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  5. Amram Kupietzky
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  6. Ido Mizrahi
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  7. Haggi Mazeh
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  8. Nahum Beglaibter
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Correspondence to Abbas Al-Kurd.

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The authors declare that they have no conflict of interest.

Informed Consent

Due to the retrospective nature of the investigation, the need for informed consent was waived.

Statement of Human and Animal Rights

This study was approved by our institutional ethics committee and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Al-Kurd, A., Grinbaum, R., Abubeih, A. et al. Not All Leaks Are Created Equal: a Comparison Between Leaks After Sleeve Gastrectomy and Roux-En-Y Gastric Bypass. OBES SURG 28, 3775–3782 (2018). https://doi.org/10.1007/s11695-018-3409-3

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