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Is There a Place for Pigtail Drains in the Management of Gastric Leaks After Laparoscopic Sleeve Gastrectomy?

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Abstract

Laparoscopic sleeve gastrectomy (LSG) has a specific morbidity profile in which gastric leak (GL) is the main complication. With a view to defining a standardized protocol for GL management, the present retrospective study sought to describe the clinical patterns of post-LSG GL and treatment of the latter in our university medical center. From July 2004 to December 2010, 25 patients were included. GL was described in terms of clinical presentation, time to onset, and location in the staple line. Treatment of GL with pharmacologic, radiologic, endoscopic, and/or surgical procedures was always validated by a multidisciplinary care team. “Treatment success” was defined as the absence of contrast agent leakage on CT and endoscopy after removal of covered metallic stent or pigtail drains. Systemic inflammation and peritonitis were the main signs for early-onset GL (56%), whereas pulmonary symptoms and intra-abdominal abscesses revealed delayed-onset GL (44%). Surgery was always performed for early-onset GL. In the total study population, the median number of endoscopic procedures was five (range, 1–11) per patient, of covered SEMS was three (range, 1–8), and of pigtail drains was three (range, 1–4). Nine (36%) patients presented endoscopic-related complications. Four (16%) patients with treatment failure underwent radical surgery. The mortality rate was 4% (n=1). The management of post-LSG GL is challenging. Surgery was always performed for early-onset GL, whereas treatment of delayed-onset GL was based on endoscopy. Pigtail drains required fewer procedures per patient, were better tolerated, and had lower morbidity–mortality than covered SEMS.

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Abbreviations

LSG:

Laparoscopic sleeve gastrectomy

BMI:

Body mass index

GL:

Gastric leak

GE:

Gastrografin esophagography

POD:

Post-operative day

SEMS:

Self-expandable metallic stent

LABG:

Laparoscopic adjustable gastric band

LGBP:

Laparoscopic gastric bypass

EWL:

Excess weight loss

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Conflicts of Interest

All contributing authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Department of Digestive and Metabolic Surgery, Amiens University Medical Center and Jules Verne University of Picardie, North Hospital, Place Victor Pauchet, 80054, Amiens Cedex 01, France

    A. Pequignot, D. Fuks, P. Verhaeghe, A. Dhahri, O. Brehant & J.-M. Regimbeau

  2. Department of Clinical and Endoscopic Gastroenterology, Amiens University Medical Center and Jules Verne University of Picardie, North Hospital, Place Victor Pauchet, 80054, Amiens Cedex 01, France

    E. Bartoli & R. Delcenserie

  3. Department of Radiology, Amiens University Medical Center and Jules Verne University of Picardie, North Hospital, Place Victor Pauchet, 80054, Amiens Cedex 01, France

    T. Yzet

  4. Department of Digestive Surgery, CHU Nord, Place Victor Pauchet, 80054, Amiens Cedex 01, France

    P. Verhaeghe

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  1. A. Pequignot
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  2. D. Fuks
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  3. P. Verhaeghe
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  4. A. Dhahri
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  5. O. Brehant
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  6. E. Bartoli
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  7. R. Delcenserie
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  9. J.-M. Regimbeau
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Corresponding author

Correspondence to J.-M. Regimbeau.

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Pequignot, A., Fuks, D., Verhaeghe, P. et al. Is There a Place for Pigtail Drains in the Management of Gastric Leaks After Laparoscopic Sleeve Gastrectomy?. OBES SURG 22, 712–720 (2012). https://doi.org/10.1007/s11695-012-0597-0

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