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Factors that promote successful endoscopic management of laparoscopic sleeve gastrectomy leaks

  • 2020 SAGES Oral
  • Published:
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Abstract

Introduction

Staple line leaks following laparoscopic sleeve gastrectomy (LSG) are associated with significant morbidity and mortality. Endoluminal techniques, including stent placement and endoluminal vacuum therapy (EVAC), have become viable options to treat these patients without the need for additional surgery. The purpose of this study was to define the conditions where certain endoscopic therapies are most likely to succeed compared to surgery.

Methods

An IRB approved prospectively maintained database was retrospectively reviewed for all patients treated for gastrointestinal leaks from July 2013 to March 2019. All patients who were treated for gastrointestinal leaks following LSG were included. Endpoints include success of leak closure and hospital-related morbidity for the patients treated solely by endoscopic only methods (EP) compared to the additional surgery group (SP).

Results

There were 39 patients (33 females; 6 males) with a median age of 45.9 years. The EP group included 23 patients (59%), whereas SP included 16 patients (31%). On average, the SP had longer days from sentinel surgery to our hospital admission (70 vs 41), a higher percentage of previous bariatric surgery prior to sentinel LSG (50% vs 17%), and a higher readmission rates following discharge (50% vs 39%). Total length of stay was also higher in the SP compared to the EP (45.4 vs 11). Using this data, a treatment algorithm was developed to optimally treat future patients who suffer from gastrointestinal leaks following LSG.

Conclusions

Endoscopic therapies, such as EVAC, stent placement, internal drainage, and over-the-scope clips, have a higher chance of success if performed earlier to their sentinel surgery and if patients have had no prior bariatric surgeries. Patients who require additional surgery tend to have longer hospital stays and readmission rates. Using the treatment algorithm provided can help determine when endoscopic therapies are likely to succeed.

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Authors and Affiliations

  1. Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA

    Marc A. Ward & Steven G. Leeds

  2. Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA

    Marc A. Ward, Daniel G. Davis & Steven G. Leeds

  3. Texas A&M College of Medicine, Bryan, TX, USA

    Marc A. Ward, Ahmed Ebrahim, Jessica S. Clothier, Daniel G. Davis & Steven G. Leeds

  4. Research Institute, Baylor Scott and White Health, Dallas, TX, USA

    Purvi K. Prajapati & Gerald O. Ogola

  5. Center for Metabolic and Weight Loss Surgery, Baylor University Medical Center, Dallas, TX, USA

    Daniel G. Davis

  6. Center for Advanced Surgery, Baylor Scott and White Health, 3417 Gaston Avenue, Suite 1000 East, Dallas, TX, 75246, USA

    Marc A. Ward

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  1. Marc A. Ward
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  2. Ahmed Ebrahim
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  3. Jessica S. Clothier
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  4. Purvi K. Prajapati
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  5. Gerald O. Ogola
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  6. Daniel G. Davis
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  7. Steven G. Leeds
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Corresponding author

Correspondence to Marc A. Ward.

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Disclosures

Daniel G. Davis is a consultant for Intuitive Surgical. Steven G. Leeds is a consultant for Ethicon and Boston Scientific. Marc A. Ward, Ahmed Ebrahim, Jessica S. Clothier, Purvi K. Prajapati, and Gerald O. Ogola have no conflicts of interest.

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Ward, M.A., Ebrahim, A., Clothier, J.S. et al. Factors that promote successful endoscopic management of laparoscopic sleeve gastrectomy leaks. Surg Endosc 35, 4638–4643 (2021). https://doi.org/10.1007/s00464-020-07890-0

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  • DOI: https://doi.org/10.1007/s00464-020-07890-0

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