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Management of 69 Gastric Leakages after 4294 Consecutive Sleeve: The Experience of a High Volume Bariatric Center

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Abstract

Purpose

To propose an algorithm of treatment for leakage after laparoscopic sleeve gastrectomy (LSG).

Materials and Methods

Sixty-nine patients who developed gastric leakage out of 4294 patients who underwent LSG from 2010 to 2018 were considered in this study. Patients’ outcomes in terms of incidence of resolution and time to leakage resolution were compared by leakage characteristics and type of treatment. Three patients were lost to follow up.

Results

Leakage occurred in a median of 6 days from surgery, and for majority of patients (80.3%), it was in the upper part of the sleeve. The median dimension of leakage was 6.5 mm. Low level leakage resulted in a lower time of resolution (p < 0.001). Patients with clinical leakage were treated with surgery or endoscopic placement of a self-expandable metal stent (SEMS). The median time of leakage resolution was 42 days. The hospitalization time for SEMS was shorter with a 68.3% of complete resolution compared with the 29.4% of surgery. In patients with subclinical and small leakage, a conservative treatment was successful in 87.5%. Overall 39.4% of patients needed a second line treatment after that the first failed.

Conclusion

Leakage could be treated conservatively if subclinical and < 5 mm. Surgery is mandatory if a perigastric collection is present or an organ lesion is suspected. SEMS seems to be the best option to treat high level leakage.

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Authors and Affiliations

  1. Department of Surgery, S.I.C.OB. (Italian Society of Bariatric Surgery) Referral Center for Bariatric Surgery, Policlinico San Marco, 24040 Zingonia-Osio Sotto, Bergamo, Italy

    Stefano Olmi, Giovanni Cesana, Alberto Oldani, Matteo Uccelli, Stefano De Carli, Francesca Ciccarese, Riccardo Giorgi, Roberta Villa, Adelinda Zanoni & Ayman Ismail

  2. University of Milan, via Francesco Sforza 35, 20122, Milan, Italy

    Stefano Olmi, Giovanni Cesana, Carolina Rubicondo & Francesca Ciccarese

Authors
  1. Stefano Olmi
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  2. Giovanni Cesana
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  3. Carolina Rubicondo
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  4. Alberto Oldani
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  5. Matteo Uccelli
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  6. Stefano De Carli
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  7. Francesca Ciccarese
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  8. Riccardo Giorgi
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  9. Roberta Villa
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  10. Adelinda Zanoni
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  11. Ayman Ismail
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Corresponding author

Correspondence to Giovanni Cesana.

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Conflict of Interest

The the authors declare that they have no conflict of interest.

Ethical Approval

All procedures in this study 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

Informed consent was obtained from all individual participants included in the study.

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Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Stefano Olmi is a “Contract Professor” of the General Surgery Faculty and a teacher in the Residency Program.

Giovanni Cesana and Francesca Ciccarese are “Tutor” in the General Surgery Residency Program.

Carolina Rubicondo is a Resident in General Surgery.

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Olmi, S., Cesana, G., Rubicondo, C. et al. Management of 69 Gastric Leakages after 4294 Consecutive Sleeve: The Experience of a High Volume Bariatric Center. OBES SURG 30, 3084–3092 (2020). https://doi.org/10.1007/s11695-020-04658-2

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  • DOI: https://doi.org/10.1007/s11695-020-04658-2

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