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Enteric Leaks After Sleeve Gastrectomy: Prevention and Management

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Bariatric Surgery Complications and Emergencies

Abstract

Laparoscopic sleeve gastrectomy (LSG) is safe and effective for the treatment of morbid obesity. Leaks after LSG are rare (~1–3 %) but can result in significant morbidity. Utilizing bougie ≥40Fr may decrease leak rate without affecting overall weight loss up to 36 months postoperatively. For patients who develop leak after LSG, nutritional support and source control are cornerstones of management, including laparoscopic drainage and washout and feeding jejunostomy tube, if necessary. Most leaks resolve with endoscopic stenting. In rare cases, surgery (resection with Roux-en-Y esophagojejunostomy or placement of Roux limb to the fistula) is required for definitive management.

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References

  1. Nguyen NT, Nguyen B, Gebhart A, Hohmann S. Changes in the makeup of bariatric surgery: a national increase in use of laparoscopic sleeve gastrectomy. J Am Coll Surg. 2013;216(2):252–7.

    Article  PubMed  Google Scholar 

  2. Gagner M, Deitel M, Erickson AL, Crosby RD. Survey on laparoscopic sleeve gastrectomy (LSG) at the Fourth International Consensus Summit on Sleeve Gastrectomy. Obes Surg. 2013;23(12):2013–7.

    Article  PubMed  Google Scholar 

  3. Sakran N, Goitein D, Raziel A, Keidar A, Beglaibter N, Grinbaum R, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2013;27(1):240–5.

    Article  PubMed  Google Scholar 

  4. Parikh M, Issa R, McCrillis A, Saunders JK, Ude-Welcome A, Gagner M. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg. 2013;257(2):231–7.

    Article  PubMed  Google Scholar 

  5. Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26(6):1509–15.

    Article  PubMed  Google Scholar 

  6. Rosenthal RJ, International Sleeve Gastrectomy Expert P, Diaz AA, Arvidsson D, Baker RS, Basso N, et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8(1):8–19.

    Article  PubMed  Google Scholar 

  7. Dallal RM, Bailey L, Nahmias N. Back to basics--clinical diagnosis in bariatric surgery. Routine drains and upper GI series are unnecessary. Surg Endosc. 2007;21(12):2268–71.

    Article  PubMed  Google Scholar 

  8. Mittermair R, Sucher R, Perathoner A, Wykypiel H. Routine upper gastrointestinal swallow studies after laparoscopic sleeve gastrectomy are unnecessary. Am J Surg. 2014;207(6):897–901.

    Article  PubMed  Google Scholar 

  9. Tan JT, Kariyawasam S, Wijeratne T, Chandraratna HS. Diagnosis and management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg. 2010;20(4):403–9.

    Article  PubMed  Google Scholar 

  10. Jen S, Simillis C, Efthimiou E. A very challenging leak from a sleeve gastrectomy. Surg Obes Relat Dis. 2013;9(4):e56–9.

    Article  PubMed  Google Scholar 

  11. Burgos AM, Braghetto I, Csendes A, Maluenda F, Korn O, Yarmuch J, et al. Gastric leak after laparoscopic-sleeve gastrectomy for obesity. Obes Surg. 2009;19(12):1672–7.

    Article  PubMed  Google Scholar 

  12. Benedix F, Benedix DD, Knoll C, Weiner R, Bruns C, Manger T, et al. Are there risk factors that increase the rate of staple line leakage in patients undergoing primary sleeve gastrectomy for morbid obesity? Obes Surg. 2014;24:1610–6.

    Article  PubMed  Google Scholar 

  13. D'Ugo S, Gentileschi P, Benavoli D, Cerci M, Gaspari A, Berta RD, et al. Comparative use of different techniques for leak and bleeding prevention during laparoscopic sleeve gastrectomy: a multicenter study. Surg Obes Relat Dis. 2014;10(3):450–4.

    Article  PubMed  Google Scholar 

  14. Bellanger DE, Greenway FL. Laparoscopic sleeve gastrectomy, 529 cases without a leak: short-term results and technical considerations. Obes Surg. 2011;21(2):146–50.

    Article  PubMed  Google Scholar 

  15. Gagner M. Leaks after sleeve gastrectomy are associated with smaller bougies. Prevention and treatment strategies. Surg Laparosc Endosc Percutan Tech. 2010;20:166–9.

    Article  PubMed  Google Scholar 

  16. Consten EC, Gagner M, Pomp A, Inabnet WB. Decreased bleeding after laparoscopic sleeve gastrectomy with or without duodenal switch for morbid obesity using a stapled buttressed absorbable polymer membrane. Obes Surg. 2004;14(10):1360–6.

    Article  PubMed  Google Scholar 

  17. Knapps J, Ghanem M, Clements J, Merchant AM. A systematic review of staple-line reinforcement in laparoscopic sleeve gastrectomy. JSLS. 2013;17(3):390–9.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Gagner M, Buchwald JN. Comparison of laparoscopic sleeve gastrectomy leak rates in four staple-line reinforcement options: a systematic review. Surg Obes Relat Dis. 2014;10(4):713–23.

    Article  PubMed  Google Scholar 

  19. Rossetti G, Fei L, Docimo L, Del Genio G, Micanti F, Belfiore A, et al. Is nasogastric decompression useful in prevention of leaks after laparoscopic sleeve gastrectomy? A randomized trial. J Invest Surg. 2014;27(4):234–9.

    Article  PubMed  Google Scholar 

  20. de Aretxabala X, Leon J, Wiedmaier G, Turu I, Ovalle C, Maluenda F, et al. Gastric leak after sleeve gastrectomy: analysis of its management. Obes Surg. 2011;21(8):1232–7.

    Article  PubMed  Google Scholar 

  21. Casella G, Soricelli E, Rizzello M, Trentino P, Fiocca F, Fantini A, et al. Nonsurgical treatment of staple line leaks after laparoscopic sleeve gastrectomy. Obes Surg. 2009;19:821–6.

    Article  CAS  PubMed  Google Scholar 

  22. Alazmi W, Al-Sabah S, Ali DA, Almazeedi S. Treating sleeve gastrectomy leak with endoscopic stenting: the kuwaiti experience and review of recent literature. Surg Endosc. 2014;28(12):3425–8.

    Article  PubMed  Google Scholar 

  23. Simon F, Siciliano I, Gillet A, Castel B, Coffin B, Msika S. Gastric leak after laparoscopic sleeve gastrectomy: early covered self-expandable stent reduces healing time. Obes Surg. 2013;23(5):687–92.

    Article  CAS  PubMed  Google Scholar 

  24. Fukumoto R, Orlina J, McGinty J, Teixeira J. Use of Polyflex stents in treatment of acute esophageal and gastric leaks after bariatric surgery. Surg Obes Relat Dis. 2007;3(1):68–72.

    Article  PubMed  Google Scholar 

  25. Corona M, Zini C, Allegritti M, Boatta E, Lucatelli P, Cannavale A, et al. Minimally invasive treatment of gastric leak after sleeve gastrectomy. Radiol Med. 2013;118(6):962–70.

    Article  PubMed  Google Scholar 

  26. Nguyen NT, Nguyen XM, Dholakia C. The use of endoscopic stent in management of leaks after sleeve gastrectomy. Obes Surg. 2010;20(9):1289–92.

    Article  PubMed  Google Scholar 

  27. Moszkowicz D, Arienzo R, Khettab I, Rahmi G, Zinzindohoue F, Berger A, et al. Sleeve gastrectomy severe complications: is it always a reasonable surgical option? Obes Surg. 2013;23(5):676–86.

    Article  PubMed  Google Scholar 

  28. Pequignot A, Fuks D, Verhaeghe P, Dhahri A, Brehant O, Bartoli E, et al. Is there a place for pigtail drains in the management of gastric leaks after laparoscopic sleeve gastrectomy? Obes Surg. 2012;22(5):712–20.

    Article  CAS  PubMed  Google Scholar 

  29. Donatelli G, Ferretti S, Vergeau BM, Dhumane P, Dumont JL, Derhy S, et al. Endoscopic Internal Drainage with Enteral Nutrition (EDEN) for treatment of leaks following sleeve gastrectomy. Obes Surg. 2014;24(8):1400–7.

    Article  PubMed  Google Scholar 

  30. Dakwar A, Assalia A, Khamaysi I, Kluger Y, Mahajna A. Late complication of laparoscopic sleeve gastrectomy. Case Rep Gastrointest Med. 2013;2013:136153.

    PubMed  PubMed Central  Google Scholar 

  31. Kim Z, Kim YJ, Kim YJ, Goo D, Cho J. Successful management of staple line leak after laparoscopic sleeve gatrectomy with vascular plug and covered stent. Surg Laparosc Endosc Percutan Tech. 2011;21:e206–8.

    Article  PubMed  Google Scholar 

  32. Oshiro T, Saiki A, Suzuki J, Satoh A, Kitahara T, Kadoya K, et al. Percutaneous transesophageal gastro-tubing for management of gastric leakage after sleeve gastrectomy. Obes Surg. 2014;24(9):1576–80.

    Article  PubMed  Google Scholar 

  33. El Hassan E, Mohamed A, Ibrahim M, Margarita M, Al Hadad M, Nimeri AA. Single-stage operative management of laparoscopic sleeve gastrectomy leaks without endoscopic stent placement. Obes Surg. 2013;23(5):722–6.

    Article  PubMed  Google Scholar 

  34. Thompson III CE, Ahmad H, Lo Menzo E, Szomstein S, Rosenthal RJ. Outcomes of laparoscopic proximal gastrectomy with esophagojejunal reconstruction for chronic staple line disruption after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2014;10(3):455–9.

    Article  PubMed  Google Scholar 

  35. Nedelcu A, Skalli M, Deneve E, Fabre J, Nocca D. Surgical managemnt of chronic fistula after sleeve gastrectomy. Surg Obes Relat Dis. 2013;9:879–84.

    Article  PubMed  Google Scholar 

  36. van de Vrande S, Himpens J, El Mourad H, Debaerdemaeker R, Leman G. Management of chronic proximal fistulas after sleeve gastrectomy by laparoscopic Roux-limb placement. Surg Obes Relat Dis. 2013;9(6):856–61.

    Article  PubMed  Google Scholar 

  37. Chour M, Alami RS, Sleilaty F, Wakim R. The early use of Roux limb as surgical treatment for proximal postsleeve gastrectomy leaks. Surg Obes Relat Dis. 2014;10(1):106–10.

    Article  PubMed  Google Scholar 

  38. Parikh M, Gagner M, Pomp A. Laparoscopic duodenal switch. In: Nguyen NT, De Maria EJ, Ikramuddin S, Hutter MM, editors. The SAGES manual: a practical guide to bariatric surgery. New York: Springer; 2008. p. 109–29.

    Chapter  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, New York University Medical Center/Bellevue Hospital, 550 First Avenue, NBV 15 South 7, New York, NY, 10016, USA

    Monica Sethi MD & Manish Parikh MD

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  1. Monica Sethi MD
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  2. Manish Parikh MD
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Correspondence to Manish Parikh MD .

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Editors and Affiliations

  1. Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA

    Daniel M. Herron

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© 2016 Springer International Publishing Switzerland

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Sethi, M., Parikh, M. (2016). Enteric Leaks After Sleeve Gastrectomy: Prevention and Management. In: Herron, D. (eds) Bariatric Surgery Complications and Emergencies. Springer, Cham. https://doi.org/10.1007/978-3-319-27114-9_7

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  • DOI: https://doi.org/10.1007/978-3-319-27114-9_7

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-27112-5

  • Online ISBN: 978-3-319-27114-9

  • eBook Packages: MedicineMedicine (R0)

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