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Postoperative Bleeding and Leakage After Sleeve Gastrectomy: a Single-Center Experience

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Abstract

Background

Sleeve gastrectomy is being performed increasingly, mainly due to its low morbidity and mortality, but complications do occur. The aim of this study was to evaluate bleeding and leakage rates of primary and revisional sleeve gastrectomy in a personal series of 664 consecutive patients.

Methods

Medical charts of all patients undergoing a primary or revisional sleeve gastrectomy between August 2008 and December 2014 were reviewed retrospectively. Subgroup analysis compared bleeding in patients after reduced port versus multiport technique and primary versus revisional sleeve gastrectomy.

Results

A total of 664 sleeve gastrectomies (489 women and 175 men) were performed. Mean age and body mass index were 36.03 ± 11.4 years and 42.9 ± 8.3 kg/m2, respectively. Mean operative time was 58.5 ± 20.0 min, with a 0.15 % conversion rate. Mean hospital stay was 2.1 ± 0.3 days. The overall 30-day complication rate was 7.5 %. Thirteen patients sustained postoperative bleeding (2 %), three of whom required reoperation (0.5 %). Staple line leakage and mortality were both nil in this series. No difference in postoperative complications was found between the subgroups.

Conclusions

In this single-surgeon, single-center experience, sleeve gastrectomy was a safe and effective bariatric procedure with a low complication rate. Staple line reinforcement by oversewing was associated with low bleeding complications and no leakage. The majority of patients with postoperative bleeding could be managed conservatively. In our experience, reduced port technique and revisional sleeve gastrectomy had similar complication rates compared to multiport and primary sleeve gastrectomy.

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References

  1. Ren CJ, Patterson E, Gagner M. Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients. Obes Surg. 2000;10:514–23. Discussion 524.

    Article  CAS  PubMed  Google Scholar 

  2. Mittermair R, Sucher R, Perathoner A. Results and complications after laparoscopic sleeve gastrectomy. Surg Today. 2014;44:1307–12.

    Article  PubMed  Google Scholar 

  3. Himpens J, Dapri G, Cadière GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg. 2006;16:1450–6.

    Article  PubMed  Google Scholar 

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

    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;257:231–7. doi:10.1097/SLA.0b013e31826cc714.

    Article  PubMed  Google Scholar 

  6. Knapps J, Ghanem M, Clements J, et al. A systematic review of staple-line reinforcement in laparoscopic sleeve gastrectomy. JSLS. 2013;17:390–9. doi:10.4293/108680813X13654754534639.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Aggarwal S, Sharma AP, Ramaswamy N. Outcome of laparoscopic sleeve gastrectomy with and without staple line oversewing in morbidly obese patients: a randomized study. J Laparoendosc Adv Surg Tech A. 2013;23:895–9. doi:10.1089/lap.2013.0137.

    Article  PubMed  Google Scholar 

  8. Albanopoulos K, Alevizos L, Flessas J, et al. Reinforcing the staple line during laparoscopic sleeve gastrectomy: prospective randomized clinical study comparing two different techniques. Preliminary results. Obes Surg. 2012;22:42–6. doi:10.1007/s11695-011-0421-2.

    Article  PubMed  Google Scholar 

  9. Dapri G, Cadière GB, Himpens J. Reinforcing the staple line during laparoscopic sleeve gastrectomy: prospective randomized clinical study comparing three different techniques. Obes Surg. 2010;20:462–7. doi:10.1007/s11695-009-0047-9.

    Article  PubMed  Google Scholar 

  10. Gentileschi P, Camperchioli I, D’Ugo S, et al. Staple-line reinforcement during laparoscopic sleeve gastrectomy using three different techniques: a randomized trial. Surg Endosc. 2012;26:2623–9. doi:10.1007/s00464-012-2243-2.

    Article  PubMed  Google Scholar 

  11. Chen B, Kiriakopolous A, Tsakayannis D, et al. Reinforcement does not necessarily reduce the rate of staple line leaks after sleeve gastrectomy. A review of the literature and clinical experiences. Obes Surg. 2009;19:166–72. doi:10.1007/s11695-008-9668-7.

    Article  PubMed  Google Scholar 

  12. Giannopoulos GA, Tzanakis NE, Rallis GE, et al. Staple line reinforcement in laparoscopic bariatric surgery: does it actually make a difference? A systematic review and meta-analysis. Surg Endosc. 2010;24:2782–8. doi:10.1007/s00464-010-1047-5.

    Article  PubMed  Google Scholar 

  13. Choi YY, Bae J, Hur KY, et al. Reinforcing the staple line during laparoscopic sleeve gastrectomy: does it have advantages? A meta-analysis. Obes Surg. 2012;22:1206–13. doi:10.1007/s11695-012-0674-4.

    Article  PubMed  Google Scholar 

  14. 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;25:88–97. doi:10.1007/s00464-010-1136-5.

    Article  PubMed  Google Scholar 

  15. Durmush E, Ermerak G, Durmush D. Short-term outcomes of sleeve gastrectomy for morbid obesity: does staple line reinforcement matter? Obes Surg. 2014;24:1109–16. doi:10.1007/s11695-014-1251-9.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Al Hajj G, Haddad J. Preventing staple-line leak in sleeve gastrectomy: reinforcement with bovine pericardium vs oversewing. Obes Surg. 2013;23:1915–21. doi:10.1007/s11695-013-1062-4.

    Article  PubMed  Google Scholar 

  17. Deitel M, Gagner M, Erickson AL, et al. Third International Summit: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2011;7:749–59. doi:10.1016/j.soard.2011.07.017.

    Article  PubMed  Google Scholar 

  18. Inabnet 3rd WB, Belle SH, Bessler M, et al. Comparison of 30-day outcomes after non-LapBand primary and revisional bariatric surgical procedures from the longitudinal assessment of bariatric surgery study. Surg Obes Relat Dis. 2010;6:22–30. doi:10.1016/j.soard.2009.10.007.

    Article  PubMed  Google Scholar 

  19. Berende CA, de Zoete JP, Smulders JF, et al. Laparoscopic sleeve gastrectomy feasible for bariatric revision surgery. Obes Surg. 2012;22:330–4. doi:10.1007/s11695-011-0501-3.

    Article  PubMed  Google Scholar 

  20. Goitein D, Feigin A, Segal-Lieberman G, et al. Laparoscopic sleeve gastrectomy as a revisional option after gastric band failure. Surg Endosc. 2011;25:2626–30. doi:10.1007/s00464-011-1615-3.

    Article  PubMed  Google Scholar 

  21. Obeid NR, Schwack BF, Kurian MS, et al. Single-stage versus 2-stage sleeve gastrectomy as a conversion after failed adjustable gastric banding: 30-day outcomes. Surg Endosc. 2014;28:3186–92. doi:10.1007/s00464-014-3585-8.

    Article  PubMed  Google Scholar 

  22. Kim SM, Ha MH, Seo JE, et al. Comparison of reduced port Totally Laparoscopic Distal Gastrectomy (Duet TLDG) and conventional laparoscopic-assisted distal gastrectomy. Ann Surg Oncol. 2015;22:2567–72. doi:10.1245/s10434-014-4333-y.

    Article  PubMed  Google Scholar 

  23. Saber AA, Elgamal MH, Itawi EA, et al. Single incision laparoscopic sleeve gastrectomy (SILS): a novel technique. Obes Surg. 2008;18:1338–42. doi:10.1007/s11695-008-9646-0.

    Article  PubMed  Google Scholar 

  24. Gomberawalla A, Salamat A, Lutfi R. Outcome analysis of single incision vs traditional multiport sleeve gastrectomy: a matched cohort study. Obes Surg. 2014;24:1870–4. doi:10.1007/s11695-014-1312-0.

    Article  PubMed  Google Scholar 

  25. Lakdawala MA, Muda NH, Goel S, et al. Single-incision sleeve gastrectomy versus conventional laparoscopic sleeve gastrectomy–a randomised pilot study. Obes Surg. 2011;21:1664–70. doi:10.1007/s11695-011-0478-y.

    Article  PubMed  Google Scholar 

  26. Sucher R, Resch T, Mohr E, et al. Single-incision laparoscopic sleeve gastrectomy versus multiport laparoscopic sleeve gastrectomy: analysis of 80 cases in a single center. J Laparoendosc Adv Surg Tech A. 2014;24:83–8. doi:10.1089/lap.2013.0250.

    Article  PubMed  Google Scholar 

  27. Updated position statement on sleeve gastrectomy as a bariatric procedure. ASMBS Clinical Issues Committee. Surg Obes Relat Dis. 2012;8(3):e21-6. doi:10.1016/j.soard.2012.02.001.

  28. Lalor PF, Tucker ON, Szomstein S, et al. Complications after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2008;4:33–8.

    Article  PubMed  Google Scholar 

  29. Frezza EE, Reddy S, Gee LL, et al. Complications after sleeve gastrectomy for morbid obesity. Obes Surg. 2009;19:684–7. doi:10.1007/s11695-008-9677-6.

    Article  PubMed  Google Scholar 

  30. Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4888 patients. Surg Endosc. 2012;26:1509–15. doi:10.1007/s00464-011-2085-3.

    Article  PubMed  Google Scholar 

  31. Ojo P, Asiyanbola B, Valin E, et al. Post discharge prophylactic anticoagulation in gastric bypass patient-how safe? Obes Surg. 2008;18:791–6. doi:10.1007/s11695-007-9382-x.

    Article  PubMed  Google Scholar 

  32. Khoursheed M, Al-Bader I, Al-Asfar F, et al. Therapeutic effect of low-molecular weight heparin and incidence of lower limb deep venous thrombosis and pulmonary embolism after laparoscopic bariatric surgery. Surg Laparosc Endosc Percutan Tech. 2013;23:491–3. doi:10.1097/SLE.0b013e31828e3c92.

    Article  PubMed  Google Scholar 

  33. 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;21:2268–71.

    Article  PubMed  Google Scholar 

  34. Alvarez Uslar R, Molina H, Torres O, et al. Total gastrectomy with or without abdominal drains. A prospective randomized trial. Rev Esp Enferm Dig. 2005;97:562–9. Article in English, Spanish.

    Article  CAS  PubMed  Google Scholar 

  35. Kim J, Lee J, Hyung WJ, et al. Gastric cancer surgery without drains: a prospective randomized trial. J Gastrointest Surg. 2004;8:727–32.

    Article  PubMed  Google Scholar 

  36. Albanopoulos K, Alevizos L, Linardoutsos D, et al. Routine abdominal drains after laparoscopic sleeve gastrectomy: a retrospective review of 353 patients. Obes Surg. 2011;21:687–91. doi:10.1007/s11695-010-0343-4.

    Article  PubMed  Google Scholar 

  37. Lacy A, Obarzaba A, Pando E, et al. Revisional surgery after sleeve gastrectomy. Surg Laparosc Endosc Percutan Tech. 2010;20:351–6. doi:10.1097/SLE.0b013e3181f62895.

    Article  PubMed  Google Scholar 

  38. 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;10:713–24. doi:10.1016/j.soard.2014.01.016.

    Article  PubMed  Google Scholar 

  39. Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, et al. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8:8–19. doi:10.1016/j.soard.2011.10.019.

    Article  PubMed  Google Scholar 

  40. Stamou KM, Menenakos E, Dardamanis D, et al. Prospective comparative study of the efficacy of staple-line reinforcement in laparoscopic sleeve gastrectomy. Surg Endosc. 2011;25:3526–30. doi:10.1007/s00464-011-1752-8.

    Article  PubMed  Google Scholar 

  41. Alley J, Fenton S, Harnisch M, et al. Integrated bioabsorbable tissue reinforcement in laparoscopic sleeve gastrectomy. Obes Surg. 2011;21:1311–5. doi:10.1007/s11695-010-0313-x.

    Article  PubMed  Google Scholar 

  42. Casella G, Soricelli E, Rizello M, et al. Nonsurgical treatment of staple line leaks after laparoscopic sleeve gastrectomy. Obes Surg. 2009;19:821–6. doi:10.1007/s11695-009-9840-8.

    Article  CAS  PubMed  Google Scholar 

  43. Burgos AM, Braghetto I, Csendes A, et al. Gastric leak after laparoscopic sleeve gastrectomy for obesity. Obes Surg. 2009;19:1672–7. doi:10.1007/s11695-009-9884-9.

    Article  PubMed  Google Scholar 

  44. Cooper JD. Technique to reduce air leaks after resection of emphysematous lung. Ann Thorac Surg. 1994;57:1038–9.

    CAS  PubMed  Google Scholar 

  45. Pinheiro JS, Correa JL, Cohen RV, et al. Staple line reinforcement with new biomaterial increased burst strength pressure: an animal study. Surg Obes Relat Dis. 2006;2:397–9. discussion 400.

    Article  PubMed  Google Scholar 

  46. Kasalicky M, Michalsky D, Housova J, et al. Laparoscopic sleeve gastrectomy without an over-sewing of the staple line. Obes Surg. 2008;18:1257–62. doi:10.1007/s11695-008-9635-3.

    Article  PubMed  Google Scholar 

  47. Iannelli A, Schneck AS, Ragot E, et al. Laparoscopic sleeve gastrectomy as revisional procedure for failed gastric banding and vertical banded gastroplasty. Obes Surg. 2009;19:1216–20. doi:10.1007/s11695-009-9903-x.

    Article  PubMed  Google Scholar 

  48. Foletto M, Prevedello L, Bernante P, et al. Sleeve gastrectomy as revisional procedure for failed gastric banding or gastroplasty. Surg Obes Relat Dis. 2010;6:146–51. doi:10.1016/j.soard.2009.09.003.

    Article  PubMed  Google Scholar 

  49. Yazbek T, Safa N, Denis R, et al. Laparoscopic Sleeve Gastrectomy (LSG)—a good bariatric option for failed Laparoscopic Adjustable Gastric Banding (LAGB): a review of 90 patients. Obes Surg. 2013;23:300–5. doi:10.1007/s11695-012-0825-7.

    Article  PubMed  Google Scholar 

  50. Delgado S, Ibarzabal A, Adelsdorfer C, et al. Transumbilical single port sleeve gastrectomy: initial experience and comparative study. Surg Endosc. 2012;26:1247–53. doi:10.1007/s00464-011-2002-9.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Kuwait University, Faculty of Medicine, Kuwait City, Kuwait

    Mousa Khoursheed, Ibtisam Al-Bader, Ali Mouzannar, Aqeel Ashraf, Yousef Bahzad, Abdulla Al-Haddad, Ali Sayed & Abe Fingerhut

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  1. Mousa Khoursheed
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  2. Ibtisam Al-Bader
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  3. Ali Mouzannar
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Correspondence to Mousa Khoursheed.

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Khoursheed, M., Al-Bader, I., Mouzannar, A. et al. Postoperative Bleeding and Leakage After Sleeve Gastrectomy: a Single-Center Experience. OBES SURG 26, 2944–2951 (2016). https://doi.org/10.1007/s11695-016-2215-z

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