Skip to main content
SpringerLink
Log in

Impact of the Surgical Experience on Leak Rate After Laparoscopic Sleeve Gastrectomy

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Introduction

Laparoscopic sleeve gastrectomy (LSG) has become one of the most commonly performed bariatric procedures, largely due to several advantages it carries over more complex bariatric procedures. LSG is generally considered a straightforward procedure, but one of the major concerns is a staple line leak.

Objective

The objectives of this study are to evaluate the correlation between surgeon’s experience and leak rate and to assess the different risk factors for developing a gastric leak after LSG.

Setting: Private hospital, France.

Methods

The analysis of a single surgeon’s yearly leak rate since the introduction of LSG for possible risk factors was done.

Results

A total of 2012 LSGs were performed in between September, 2005 and December, 2014. Twenty cases (1 %) of gastric leak were recorded. Of these, 17 patients were women (94.4 %) with a mean age of 39.4 years (range 22–61) and mean body mass index (BMI) 41.2 kg/m2 (range 34.8–57.1). On a yearly basis, the leak rate was 4.8 % (2006), 5.7 % (2007), 0 (2008), 2.6 % (2009), 2 % (2010), 0.8 % (2011), 0.6 % (2012), 0.2 % (2013), and 0 (2014). In the first 1000 cases (group A), there were 18 cases of gastric leak and in the last 1000 cases, there were 800 with GORE® SEAMGUARD® Bioabsorbable Staple Line Reinforcement (group B) 2 cases of gastric leak (p = 0.009). A revisional LSG, 395 patients after gastric banding and 61 patients re-sleeve gastrectomy, was performed in 456 cases (22.7 %). There were 3 cases of leak (0.65 %). There were two deaths.

Conclusion

LSG can be performed with a low complication rate. This large series of a single surgeon’s experience demonstrated that the leak rate after LSG could be significantly decreased over time with changes in techniques.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Lazzati A, Guy-Lachuer R, Delaunay V, Azoulay D, et al. Bariatric surgery trends in France: 2005–2011. Surg Obes Relat Dis. 2014;10(2):328–34.

    Article  PubMed  Google Scholar 

  2. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–36.

    Article  PubMed  Google Scholar 

  3. Fezzi M, Kolotkin RL, Nedelcu M, et al. Improvement in quality of life after laparoscopic sleeve gastrectomy. Obes Surg. 2011;21(8):1161–7.

    Article  PubMed  Google Scholar 

  4. Noel P, Iannelli A, Sejor E, et al. Laparoscopic sleeve gastrectomy: how I do it. Surg Laparosc Endosc Percutan Tech. 2013;23(1):e14–6.

    Article  PubMed  Google Scholar 

  5. Parikh M, Issa R, McCrillis A, et al. 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 

  6. Sakran N, Goitein D, Raziel A, 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 

  7. Ali MR, Tichansky DS, Kothari SN, et al. Validation that a 1-year fellowship in minimally invasive and bariatric surgery can eliminate the learning curve for laparoscopic gastric bypass. Surg Endosc. 2010;24(1):138–44.

    Article  PubMed  Google Scholar 

  8. Geubbels N, de Brauw LM, Acherman YI, et al. The preceding surgeon factor in bariatric surgery: a positive influence on the learning curve of subsequent surgeons. Obes Surg. 2014.

  9. 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 

  10. Nedelcu M, Manos T, Cotirlet A, et al. Outcome of leaks after sleeve gastrectomy based on a new algorithm addressing leak size and gastric stenosis. Obes Surg. 2015;25(3):559–63.

    Article  PubMed  Google Scholar 

  11. Serra C, Baltasar A, Andreo L, et al. Treatment of gastric leaks with coated self-expanding stents after sleeve gastrectomy. Obes Surg. 2007;17:866–72.

    Article  PubMed  Google Scholar 

  12. Burgos AM, Braghetto I, Csendes A, et al. Gastric leak after laparoscopic-sleeve gastrectomy for obesity. Obes Surg. 2009;19:1672–7.

    Article  PubMed  Google Scholar 

  13. Sanchez-Santos R, Masdevall C, Baltasar A, et al. Short and mid-term outcomes of sleeve gastrectomy for morbid obesity: the experience of the Spanish National Registry. Obes Surg. 2009;19:1203–10.

    Article  PubMed  Google Scholar 

  14. Csendes A, Braghetto I, Leon P, et al. Management of leaks after laparoscopic sleeve gastrectomy in patients with obesity. J Gastrointest Surg. 2010;14(9):1343–8.

    Article  PubMed  Google Scholar 

  15. Tan JT, Kariyawasam S, Wijeratne T, et al. Diagnosis and management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg. 2010;20:403–9.

    Article  PubMed  Google Scholar 

  16. Barreto TW, Kemmeter PR, Paletta MP, et al. A comparison of a single center’s experience with three staple line reinforcement techniques in 1,502 laparoscopic sleeve gastrectomy patients. Obes Surg. 2014.

  17. Clinical Issues Committee of American Society for Metabolic and Bariatric Surgery. Sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis. 2007;3:573–6.

    Article  Google Scholar 

  18. Ser KH, Lee WJ, Lee YC, et al. Experience in laparoscopic sleeve gastrectomy formorbidly obese Taiwanese: staple-line reinforcement is important for preventing leakage. Surg Endosc. 2010;24(9):2253–9.

    Article  PubMed  Google Scholar 

  19. Daskalakis M, Berdan Y, Theodoridou S, et al. Impact of surgeon experience and buttress material on postoperative complications after laparoscopic sleeve gastrectomy. Surg Endosc. 2011;25(1):88–97.

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

  21. Gagner M. Meta-analysis of leaks following laparoscopic vertical sleeve gastrectomy. Obes Surg. 2011;21(8):958. abstract PL02-05; presented at the XVI World Congress of International Federation of the Surgery of Obesity (IFSO), Aug 31-Sept 3, 2011, Hamburg, Germany.

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

    Article  PubMed  Google Scholar 

  23. Rosenthal RJ. International Sleeve Gastrectomy Expert Panel 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 

Download references

Author information

Author notes

    Authors and Affiliations

    1. Hôpital Prive La Casamance, Aubagne, France

      Patrick Noel

    2. Digestive and Endocrine Surgery, University Hospital of Strasbourg, 1, Place de l’Hôpital, 67091, Strasbourg, France

      Marius Nedelcu

    3. Hôpital Du Sacré Cœur, Montréal, Canada

      Michel Gagner

    Authors
    1. Patrick Noel
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Marius Nedelcu
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Michel Gagner
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Marius Nedelcu.

    Ethics declarations

    Conflict of Interest

    M. Nedelcu has no conflicts of interest or financial ties to disclose. P. Noel has honorarium for speaking engagements Olympus and Gore. M. Gagner has received speaker honoraria from Ethicon, Covidien, GORE, MID, Boehringer Laboratories, Transenterix and Olympus. Also, he has received grants from GORE and Boehringer Laboratories, and equity from Transenterix.

    Ethical Approval

    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

    Informed Consent

    For this type of study, formal consent is not required.

    Additional information

    Patrick Noel and Marius Nedelcu contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Noel, P., Nedelcu, M. & Gagner, M. Impact of the Surgical Experience on Leak Rate After Laparoscopic Sleeve Gastrectomy. OBES SURG 26, 1782–1787 (2016). https://doi.org/10.1007/s11695-015-2003-1

    Download citation

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s11695-015-2003-1

    Keywords

    Search

    Navigation