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Management of Staple Line Leaks Following Sleeve Gastrectomy—a Systematic Review

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Abstract

Background

A staple line leak following a sleeve gastrectomy is associated with significant morbidity and mortality. No uniform guideline or consensus exists with regard to the optimal treatment approach to managing a staple line leak.

Objectives

The objective of this systematic review is to assess the efficacy and success rates of the different treatment strategies for staple line leak following sleeve gastrectomy.

Methods

A thorough search through four online electronic databases was conducted using predefined search criteria. Our primary outcome measure was to review the treatment options described in the management of the staple line leak following laparoscopic sleeve gastrectomy. Successful initial management was defined as the proportion of cases that were successfully treated using the first modality described, with no escalation to another treatment option.

Results

A total of 26 articles were included in this systematic review. Successful initial management of 62% was achieved in patients who underwent endoscopic management, 76% in those who underwent surgery and 82% in patients treated conservatively. A total of 7 patient deaths were noted, all of which were patients who underwent surgery as the initial management of their staple line leak.

Conclusion

Prompt identification and adequate source control are crucial to successfully manage a staple line leak following sleeve gastrectomy. Treatment options are influenced by the clinical status of the patient. A stepwise treatment escalation approach is required to improve outcomes.

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References

  1. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014. Obes Surg. 2017;27(9):2279–89.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Praveenraj P, Gomes RM, Kumar S, et al. Management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity: a tertiary care experience and design of a management algorithm. J Minim Access Surg. 2016;12(4):342–9.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Galloro G, Ruggiero S, Russo T, et al. Staple-line leak after sleeve gastrectomy in obese patients: a hot topic in bariatric surgery. World J Gastrointest Endosc. 2015;7(9):843–6.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Silecchia G, Iossa A. Complications of staple line and anastomoses following laparoscopic bariatric surgery. Ann Gastroenterol. 2018;31(1):56–64.

    PubMed  Google Scholar 

  5. 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 

  6. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10):1006–12.

    Article  PubMed  Google Scholar 

  7. Rosenthal RJ, International Sleeve Gastrectomy Expert P, 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(1):8–19.

    Article  PubMed  Google Scholar 

  8. Durieux N, Vandenput S, Pasleau F. OCEBM levels of evidence system. Rev Med Liege. 2013;68(12):644–9.

    CAS  PubMed  Google Scholar 

  9. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–6.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Moloney BM, Hynes DA, Kelly ME, Iqbal A, O'Connor E, Lowe D, et al. The role of laparoscopic sleeve gastrectomy as a treatment for morbid obesity; review of outcomes. Ir J Med Sci. 2017;186(1):143–9.

    Article  Google Scholar 

  11. Spicka P. Staple line leak with peritonitis after laparoscopic sleeve gastrectomy - a solution in one to six steps. Wideochir Inne Tech Maloinwazyjne. 2017;12(2):154–9.

    Article  Google Scholar 

  12. Rawlins L, Rawlins MP, Brown CC, Schumacher DL. Sleeve gastrectomy: 5-year outcomes of a single institution. Surg Obes Relat Dis. 2013;9(1):21–5.

    Article  PubMed  Google Scholar 

  13. Albanopoulos K, Alevizos L, Linardoutsos D, Menenakos E, Stamou K, Vlachos K, et al. Routine abdominal drains after laparoscopic sleeve gastrectomy: a retrospective review of 353 patients. Obes Surg. 2011;21(6):687–91.

    Article  Google Scholar 

  14. Keren D, Eyal O, Sroka G, Rainis T, Raziel A, Sakran N, et al. Over-the-Scope Clip (OTSC) System for Sleeve Gastrectomy Leaks. Obes Surg. 2015;25(8):1358–63.

    Article  Google Scholar 

  15. 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(7):821–6.

    Article  CAS  PubMed  Google Scholar 

  16. El-Sayes IA, Frenken M, Weiner RA. Management of leakage and stenosis after sleeve gastrectomy. Surgery. 2017;162(3):652–61.

    Article  PubMed  Google Scholar 

  17. Leeds SG, Burdick JS. Management of gastric leaks after sleeve gastrectomy with endoluminal vacuum (E-Vac) therapy. Surg Obes Relat Dis. 2016;12(7):1278–85.

    Article  PubMed  Google Scholar 

  18. Abd Ellatif ME, Abdallah E, Askar W, Thabet W, Aboushady M, Abbas AE, et al. Long term predictors of success after laparoscopic sleeve gastrectomy. Int J Surg. 2014;12(5):504–8.

    Article  CAS  PubMed  Google Scholar 

  19. Gibson SC, Le Page PA, Taylor CJ. Laparoscopic sleeve gastrectomy: review of 500 cases in single surgeon Australian practice. ANZ J Surg. 2015;85(9):673–7.

    Article  PubMed  Google Scholar 

  20. Hoogerboord M, Wiebe S, Klassen D, Ransom T, Lawlor D, Ellsmere J. Laparoscopic sleeve gastrectomy: perioperative outcomes, weight loss and impact on type 2 diabetes mellitus over 2 years. Can J Surg. 2014;57(2):101–5.

    Article  PubMed Central  Google Scholar 

  21. Szewczyk T, Janczak P, Janiak A, Gaszynski T, Modzelewski B. Laparoscopic sleeve gastrectomy - 7 years of own experience. Wideochir Inne Tech Maloinwazyjne. 2014;9(3):427–35.

    Article  Google Scholar 

  22. Curro G, Piscitelli G, Lazzara C, et al. Laparoscopic sleeve gastrectomy for morbid obesity: role of intraluminal and intraperitoneal postoperative drainage. G Chir. 2017;38(4):181–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Wahby M, Salama AF, Elezaby AF, et al. Is routine postoperative gastrografin study needed after laparoscopic sleeve gastrectomy? Experience of 712 cases. Obes Surg. 2013;23(11):1711–7.

    Article  CAS  PubMed  Google Scholar 

  24. 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 

  25. Sethi M, Zagzag J, Patel K, Magrath M, Somoza E, Parikh MS, et al. Intraoperative leak testing has no correlation with leak after laparoscopic sleeve gastrectomy. Surg Endosc. 2016;30(3):883–91.

    Article  PubMed  Google Scholar 

  26. Montuori M, Benavoli D, D'Ugo S, Di Benedetto L, Bianciardi E, Gaspari AL, et al. Integrated Approaches for the Management of Staple Line Leaks following Sleeve Gastrectomy. J Obes. 2017;2017:4703236.

    Article  Google Scholar 

  27. Klimczak T, Klimczak J, Szewczyk T, Janczak P, Juralowicz P. Endoscopic treatment of leaks after laparoscopic sleeve gastrectomy using MEGA esophageal covered stents. Surg Endosc. 2018;32(4):2038–45.

    Article  PubMed  Google Scholar 

  28. Southwell T, Lim TH, Ogra R. Endoscopic Therapy for Treatment of Staple Line Leaks Post-Laparoscopic Sleeve Gastrectomy (LSG): Experience from a Large Bariatric Surgery Centre in New Zealand. Obes Surg. 2016;26(6):1155–62.

    Article  Google Scholar 

  29. Behrens C, Tang BQ, Amson BJ. Early results of a Canadian laparoscopic sleeve gastrectomy experience. Can J Surg. 2011;54(2):138–43.

    Article  PubMed Central  Google Scholar 

  30. Weiner RA, El-Sayes IA, Theodoridou S, et al. Early post-operative complications: incidence, management, and impact on length of hospital stay. A retrospective comparison between laparoscopic gastric bypass and sleeve gastrectomy. Obes Surg. 2013;23(12):2004–12.

    Article  PubMed  Google Scholar 

  31. Hany M, Ibrahim M. Comparison Between Stable Line Reinforcement by Barbed Suture and Non-reinforcement in Sleeve Gastrectomy: a Randomized Prospective Controlled Study. Obes Surg. 2018;28(8):2157–64.

    Article  PubMed  Google Scholar 

  32. Nocca D, Krawczykowsky D, Bomans B, Noel P, Picot MC, Blanc PM, et al. A prospective multicenter study of 163 sleeve gastrectomies: results at 1 and 2 years. Obes Surg. 2008;18(5):560–5.

    Article  CAS  PubMed  Google Scholar 

  33. Skrekas G, Lapatsanis D, Stafyla V, Papalambros A. One year after laparoscopic "tight" sleeve gastrectomy: technique and outcome. Obes Surg. 2008;18(7):810–3.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  35. Dapri G, Cadiere GB, Himpens J. Reinforcing the staple line during laparoscopic sleeve gastrectomy: prospective randomized clinical study comparing three different techniques. Obes Surg. 2010;20(4):462–7.

    Article  PubMed  Google Scholar 

  36. Hutter MM, Schirmer BD, Jones DB, et al. First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg. 2011;254(3):410–20. discussion 20-2

    Article  PubMed  Google Scholar 

  37. Sammour T, Hill AG, Singh P, et al. Laparoscopic sleeve gastrectomy as a single-stage bariatric procedure. Obes Surg. 2010;20(3):271–5.

    Article  PubMed  Google Scholar 

  38. Benaiges D, Mas-Lorenzo A, Goday A, et al. Laparoscopic sleeve gastrectomy: more than a restrictive bariatric surgery procedure? World J Gastroenterol. 2015;21(41):11804–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. 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 

  40. 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 

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

    Article  PubMed  PubMed Central  Google Scholar 

  42. Shikora SA, Mahoney CB. Clinical benefit of gastric staple line reinforcement (SLR) in gastrointestinal surgery: a meta-analysis. Obes Surg. 2015;25(7):1133–41.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Wang H, Lu J, Feng J, et al. Staple line oversewing during laparoscopic sleeve gastrectomy. Ann R Coll Surg Engl. 2017;99(7):509–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Abou Rached A, Basile M, El Masri H. Gastric leaks post sleeve gastrectomy: review of its prevention and management. World J Gastroenterol. 2014;20(38):13904–10.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Kwon YM, Gerdes H, Schattner MA, et al. Management of peripancreatic fluid collections following partial pancreatectomy: a comparison of percutaneous versus EUS-guided drainage. Surg Endosc. 2013;27(7):2422–7.

    Article  PubMed  Google Scholar 

  46. Tilara A, Gerdes H, Allen P, et al. Endoscopic ultrasound-guided transmural drainage of postoperative pancreatic collections. J Am Coll Surg. 2014;218(1):33–40.

    Article  PubMed  Google Scholar 

  47. Neff R. Pancreatic pseudocysts and fluid collections: percutaneous approaches. Surg Clin N Am. 2001;81(2):399–403. xii

    Article  CAS  PubMed  Google Scholar 

  48. Donatelli G, Fuks D, Cereatti F, et al. Endoscopic transmural management of abdominal fluid collection following gastrointestinal, bariatric, and hepato-bilio-pancreatic surgery. Surg Endosc. 2018;32(5):2281–7.

    Article  PubMed  Google Scholar 

  49. Campos JM, Pereira EF, Evangelista LF, et al. Gastrobronchial fistula after sleeve gastrectomy and gastric bypass: endoscopic management and prevention. Obes Surg. 2011;21(10):1520–9.

    Article  PubMed  Google Scholar 

  50. Cosse C, Rebibo L, Brazier F, et al. Cost-effectiveness analysis of stent type in endoscopic treatment of gastric leak after laparoscopic sleeve gastrectomy. Br J Surg. 2018;105(5):570–7.

    Article  CAS  PubMed  Google Scholar 

  51. Donatelli G, Dumont JL, Cereatti F, et al. Treatment of leaks following sleeve gastrectomy by endoscopic internal drainage (EID). Obes Surg. 2015;25(7):1293–301.

    Article  CAS  PubMed  Google Scholar 

  52. Donatelli G, Chiche R, Cereatti F, et al. Endoscopic drainage of intra-abdominal collection after bariatric surgery. Obes Surg. 2017;27(6):1635–7.

    Article  PubMed  Google Scholar 

  53. Pequignot A, Fuks D, Verhaeghe P, 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 

  54. Baker RS, Foote J, Kemmeter P, et al. The science of stapling and leaks. Obes Surg. 2004;14(10):1290–8.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of General Surgery, Milton Keynes University Hospital, Standing Way, Eaglestone, Milton Keynes, MK6 5LD, UK

    Daniel Hughes & Achal Khanna

  2. Queen’s University Belfast, University Road, Belfast, Northern Ireland, BT7 1NN, UK

    Ioan Hughes

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  1. Daniel Hughes
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Correspondence to Daniel Hughes.

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The authors declare that they have no conflict of interest.

Informed Consent

No informed patient consent was required for this systematic review.

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Hughes, D., Hughes, I. & Khanna, A. Management of Staple Line Leaks Following Sleeve Gastrectomy—a Systematic Review. OBES SURG 29, 2759–2772 (2019). https://doi.org/10.1007/s11695-019-03896-3

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