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Long-term follow-up of a cohort with post sleeve gastrectomy leaks: results of endoscopic treatment and salvage surgery

  • 2023 SAGES Oral
  • Published:
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Abstract

Introduction

Laparoscopic sleeve gastrectomy (LSG) is the most performed bariatric procedure worldwide. The most challenging postoperative complication is gastric leak. The objectives of this study are to examine the efficacy and morbidity of different therapeutic strategies addressing leakage, and the long-term outcomes of a cohort of LSG leaks.

Methods

A retrospective review of patients treated for LSG leaks between September 2014 and January 2023 at our high-volume bariatric surgery center was performed.

Results

The charts of 37 patients (29 women and 8 men) were reviewed, with a mean age of 43 years and a median follow-up of 24 months. The mean preoperative body mass index was 45.1 kg/m2. Overall, 30/37 (81%) patients were successfully treated with endoscopic management, and 7/37 (19%) ultimately underwent salvage surgery. If the leak was diagnosed earlier than 6 weeks, endoscopic treatment had a 97% success rate. The median number of endoscopic procedures was 2 per patient, and included internal pigtails, stents, septoplasty, endoluminal vacuum therapy and over-the-scope clips. Complications included stent-related ulcers (10), esophageal stenosis requiring endoscopic dilatations (4), stent migrations (2) and kinking requiring repositioning (1), and internal pigtail migration (3). Revisional surgery consisted of proximal gastrectomy and Roux-en-Y esophago-jejunal anastomosis, Roux-en-Y fistulo-jejunostomy or classic Roux-en-Y gastric bypass proximal to the gastric stricture. In 62% of the cases, the axis/caliber of the LSG was abnormal. Beyond 4 attempts, endoscopy was unsuccessful. The success rate of endoscopic management dropped to 25% when treatment was initiated more than 45 days after the index surgery.

Conclusions

Purely endoscopic management was successful in 81% of cases; with 97% success rate if diagnosis earlier than 6 weeks. After four failed endoscopic procedures, a surgical approach should be considered. Delayed diagnosis appears to be a significant risk factor for failure of endoscopic treatment.

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Authors and Affiliations

  1. Hôpital du Sacré Coeur, Montreal, Canada

    Alexis Deffain, Heba Alfaris, Roy Hajjar, Felix Thibeault, Wael Dimassi, Ronald Denis, Pierre Y. Garneau, Anne-Sophie Studer & Radu Pescarus

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  1. Alexis Deffain
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Correspondence to Alexis Deffain.

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Alexis Deffain, Heba Alfaris, Roy Hajjar, Felix Thibeault, Wael Dimassi, Ronald Denis, Pierre Y. Garneau, Anne-Sophie Studer and Radu Pescarus have no conflicts of interest or financial ties to disclose.

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Deffain, A., Alfaris, H., Hajjar, R. et al. Long-term follow-up of a cohort with post sleeve gastrectomy leaks: results of endoscopic treatment and salvage surgery. Surg Endosc 37, 9358–9365 (2023). https://doi.org/10.1007/s00464-023-10386-2

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