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Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients

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Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) remains under scrutiny as a stand-alone bariatric procedure. The most feared complication after LSG is staple line leak.

Methods

Eight bariatric centers in Israel participated in this study. A retrospective analysis was performed by querying all the LSG cases performed between June 2006 and June 2010. The data collected included patient demographics, anthropometrics, and operative and perioperative parameters.

Results

Among the 2,834 patients who underwent LSG, 44 (1.5 %) with gastric leaks were identified. Of these 44 patients, 30 (68 %) were women. The patients had a mean age of 41.5 years and a body mass index (BMI) of 45.4 kg/m2. Intraoperative leak tests and routine postoperative swallow studies were performed with 33 patients, and all but one patient (3 %) failed to detect the leaks. Leaks were diagnosed at a median of 7 days postoperatively: early (0–2 days) in nine cases (20 %), intermediately (3–14 days) in 32 cases (73 %), and late (>14 days) in three cases (7 %). For 38 patients (86 %), there was clinical suspicion, later confirmed by imaging or operative findings. Computed tomography, swallow studies, and methylene blue tests were performed for 37, 21, and 15 patients, respectively, and the results were positive, respectively, for 31 (84 %), 11 (50 %), and 9 (60 %) of these patients. Reoperation was performed for 27 of the patients (61 %). Other treatment methods included percutaneous drainage (n = 28, 63.6 %), endoscopic placement of stents (n = 11, 25 %), clips (n = 1, 2.3 %), and fibrin glue (n = 1, 2.3 %). In 33 of the patients (75 %), the leak site was found in the upper sleeve near the gastroesophageal junction. The median time to leak closure was 40 days (range, 2–270 days), and the overall leak-related mortality rate was 0.14 % (4/2,834).

Conclusion

Gastric leak is the most common cause of major morbidity and mortality after LSG. Routine tests to rule out leaks seem to be superfluous. Rather, selective utilization is recommended. Management options vary, depending mainly on patient disposition. An accepted algorithm for the diagnosis and treatment of gastric leak has yet to be proposed.

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Disclosures

Nasser Sakran, David Goitein, Asnat Raziel, Andrei Keidar, Nahum Beglaibter, Ronit Grinbaum, Ibrahim Matter, Ricardo Alfici, Ahmad Mahajna, Igor Waksman, Mordechai Shimonov, and Ahmad Assalia have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery, Hillel Yaffe Medical Center, P.O. Box 169, 38100, Hadera, Israel

    Nasser Sakran & Ricardo Alfici

  2. Chaim Sheba Medical Center, Tel Hashomer, Israel

    David Goitein

  3. Assia Medical Group, Assuta Hospital, Tel Aviv, Israel

    Asnat Raziel

  4. Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    Andrei Keidar, Nahum Beglaibter & Ronit Grinbaum

  5. Bnai Zion Medical Center, Haifa, Israel

    Ibrahim Matter

  6. Rambam Health Care Campus, Haifa, Israel

    Ahmad Mahajna & Ahmad Assalia

  7. Ziv Medical Center, Zefat, Israel

    Igor Waksman

  8. Wolfson Medical Center, Holon, Israel

    Mordechai Shimonov

  9. Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel

    Nasser Sakran, Ibrahim Matter, Ricardo Alfici, Ahmad Mahajna & Ahmad Assalia

  10. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    David Goitein & Mordechai Shimonov

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  1. Nasser Sakran
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  2. David Goitein
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  3. Asnat Raziel
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  12. Ahmad Assalia
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Corresponding author

Correspondence to Nasser Sakran.

Additional information

Nasser Sakran and David Goitein have equally contributed to this paper.

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Sakran, N., Goitein, D., Raziel, A. et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc 27, 240–245 (2013). https://doi.org/10.1007/s00464-012-2426-x

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  • DOI: https://doi.org/10.1007/s00464-012-2426-x

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