Obesity Surgery

, Volume 20, Issue 4, pp 403–409

Diagnosis and Management of Gastric Leaks After Laparoscopic Sleeve Gastrectomy for Morbid Obesity

  • Jeremy T. Tan
  • Sanjeeva Kariyawasam
  • Thejana Wijeratne
  • Harsha S. Chandraratna
Clinical Research



Laparoscopic sleeve gastrectomy (LSG) is increasingly being recognised as a valid stand-alone procedure for the surgical management of morbid obesity. The leak rate from the gastric staple line ranges from 1.4% to 20%. From our experience of management of LSG leaks, we have been able to formulate an algorithm-based approach to the management of these patients.


All patients referred to our hospital within a 24-month period with a diagnosis of gastric staple line leak in the background of a previous LSG were included in the study. A retrospective case note review was undertaken for these patients and an algorithm formulated.


There were fourteen patients in the study. There were four males and ten females. Patients were managed with a combination of laparotomy, laparoscopy, endoscopic covered stenting, percutaneous radiologically guided drainage, jejunal enteric feeding and total parenteral nutrition. In five patients, re-look laparoscopy or laparotomy with washout and drainage was performed. The remaining eight patients were managed conservatively. There were no deaths.


Although it is often disappointing when LSG leaks do occur, with adherence to the basic tenets of the surgical management of enterocutaneous fistulae as well as early detection and a high index of suspicion, these complications can be successfully managed using an algorithm-based multi-disciplinary team approach.


Diagnosis Management Laparoscopic Sleeve gastrectomy Leaks 


  1. 1.
    Deitel M, Crosby RD, Gagner M. The first international consensus summit for sleeve gastrectomy (SG), New York City, October 25–27, 2007. Obes Surg. 2008;18:487–96.CrossRefPubMedGoogle Scholar
  2. 2.
    Lee CM, Cirangle PT, Jossart GH. Vertical gastrectomy for morbid obesity in 216 patients: report of two-year results. Surg Endosc. 2007;21:1810–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Nocca D, Krawczyowsky D, Bomans B, et al. A prospective multicenter study of 163 sleeve gastrectomies: results at 1 and 2 years. Obes Surg. 2008;18:560–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Fuks D, Verhaeghe P, Brehant O, et al. Results of laparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity. Surgery. 2009;145:106–13.CrossRefPubMedGoogle Scholar
  5. 5.
    Himpens J, Dapri G, Cadiere 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.CrossRefPubMedGoogle Scholar
  6. 6.
    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.CrossRefPubMedGoogle Scholar
  7. 7.
    Baltasar A, Bou R, Bengochea M, et al. Use of a Roux limb to correct esophago-gastric junction fistulas after sleeve gastrectomy. Obes Surg. 2007;17:1408–10.CrossRefPubMedGoogle Scholar
  8. 8.
    Kasalicky M, Michalsky M, Housova J, et al. Laparoscopic sleeve gastrectomy without over-sewing of the staple line. Obes Surg. 2008;18:1257–62.CrossRefPubMedGoogle Scholar
  9. 9.
    Chen BO, Andreas K, Dimitrios T, et al. Reinforcement does not necessarily reduce the rate of staple line leaks after sleeve gastrectomy—a review of the literature and clinical experience. Obes Surg. 2009;19:166–72.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2009

Authors and Affiliations

  • Jeremy T. Tan
    • 1
  • Sanjeeva Kariyawasam
    • 1
  • Thejana Wijeratne
    • 1
  • Harsha S. Chandraratna
    • 1
  1. 1.Department of General SurgerySir Charles Gairdner HospitalNedlandsAustralia

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