Obesity Surgery

, Volume 27, Issue 7, pp 1780–1788 | Cite as

Staple Line Leak After Primary Sleeve Gastrectomy—Risk Factors and Mid-term Results: Do Patients Still Benefit from the Weight Loss Procedure?

  • Frank Benedix
  • Oliver Poranzke
  • Daniele Adolf
  • Stephanie Wolff
  • Hans Lippert
  • Jörg Arend
  • Thomas Manger
  • Christine Stroh
  • Obesity Surgery Working Group Competence Network Obesity
Original Contributions

Abstract

Background

Staple line leak after laparoscopic sleeve gastrectomy (LSG) still represents the most feared complication. The purpose of this study was to investigate whether there are factors that increase the risk for a leakage. Furthermore, we aimed to analyze the impact of a leak on weight change and resolution of comorbidities.

Methods

Since 2005, data from obese patients that undergo bariatric procedures in Germany are prospectively registered. For the current analysis, all adult subjects that had undergone primary LSG from 2005 to 2014 were considered.

Results

Overall, 241/15,756 (1.53%) patients experienced a leak. The occurrence of a leakage resulted in a significant increase of the mortality rate (3.7 vs. 0.2%; p < 0.01). Percent excess weight loss did not differ between leak and non-leak patients, both, at 12 (64.2 vs. 60.9%; p = 1.0) and 24 months (68.5 vs. 64.0%, p = 0.86). Similarly, no significant difference was observed for resolution rate of all comorbid conditions. Matched pair analysis confirmed these findings. Multivariable analysis identified operation time, conversion, intraoperative complications, and hypertension and degenerative joint disease as risk factors for a leak. Oversewing the staple line was associated with the lowest risk.

Conclusion

The postoperative staple line leak after primary LSG significantly increases postoperative morbidity and mortality. We found that there are patient-related factors and operative variables that predispose to leakage after LSG. However, the occurrence of a leakage does not adversely impact the weight loss and resolution of comorbidities in the mid-term.

Keywords

Sleeve gastrectomy Leakage Outcome Risk factors German multicenter trial 

References

  1. 1.
    Berger ER, Clements RH, Morton JM, et al. The impact of different surgical techniques on outcomes in laparoscopic sleeve gastrectomies: the first report from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). Ann Surg. 2016;264:464–73.CrossRefPubMedGoogle Scholar
  2. 2.
    Benaiges D, Más-Lorenzo A, Goday A, et al. Laparoscopic sleeve gastrectomy: more than a restrictive bariatric surgery procedure? World J Gastroenterol. 2015;21:11804–14.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Shi X, Karmali S, Sharma AM, et al. A review of laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg. 2010;20:1171–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Bohdjalian A, Langer FB, Shakeri-Leidenmühler S, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg. 2010;20:535–40.CrossRefPubMedGoogle Scholar
  5. 5.
    Burgos AM, Braghetto I, Csendes A, et al. Gastric leak after laparoscopic-sleeve gastrectomy for obesity. Obes Surg. 2009;19:1672–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Moy J, Pomp A, Dakin G, et al. Laparoscopic sleeve gastrectomy for morbid obesity. Am J Surg. 2008;196:e56–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Gagner M, Deitel M, Erickson AL, et al. Survey on laparoscopic sleeve gastrectomy (LSG) at the Fourth International Consensus Summit on Sleeve Gastrectomy. Obes Surg. 2013;23:2013–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Hutter MM, Schirmer BD, Jones DB, et al. First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg. 2011;254:410–20.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Abou Rached A, Basile M, El Masri H. Gastric leaks post sleeve gastrectomy: review of its prevention and management. World J Gastroenterol. 2014;20:13904–10.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Shikora SA, Mahoney CB. Clinical benefit of gastric staple line reinforcement (SLR) in gastrointestinal surgery: a meta-analysis. Obes Surg. 2015;25:1133–41.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25:1822–32.CrossRefPubMedGoogle Scholar
  12. 12.
    Gagner M, Buchwald JN. Comparison of laparoscopic sleeve gastrectomy leak rates in four staple-line reinforcement options: a systematic review. Surg Obes Relat Dis. 2014;10:713–23.CrossRefPubMedGoogle Scholar
  13. 13.
    Jurowich C, Thalheimer A, Seyfried F, et al. Gastric leakage after sleeve gastrectomy-clinical presentation and therapeutic options. Langenbeck's Arch Surg. 2011;396:981–7.CrossRefGoogle Scholar
  14. 14.
    Fischer L, Hildebrandt C, Bruckner T, et al. Excessive weight loss after sleeve gastrectomy: a systematic review. Obes Surg. 2012;22:721–31.CrossRefPubMedGoogle Scholar
  15. 15.
    Rebibo L, Dhahri A, Maréchal V, et al. Gastric leaks after sleeve gastrectomy: no impact on weight loss, co-morbidities, and satisfaction rates. Surg Obes Relat Dis. 2016;12:502–10.CrossRefPubMedGoogle Scholar
  16. 16.
    Matsui H, Shimokawa O, Kaneko T, et al. The pathophysiology of non-steroidal anti-inflammatory drug (NSAID)-induced mucosal injuries in stomach and small intestine. J Clin Biochem Nutr. 2011;48:107–11.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Cardile S, Martinelli M, Barabino A, et al. Italian survey on non-steroidal anti-inflammatory drugs and gastrointestinal bleeding in children. World J Gastroenterol. 2016;22:1877–83.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    DeMaria EJ, Portenier D, Wolfe L. Obesity surgery mortality risk score: proposal for a clinically useful score to predict mortality risk in patients undergoing gastric bypass. Surg Obes Relat Dis. 2007;3:134–40.CrossRefPubMedGoogle Scholar
  19. 19.
    Iossa A, Abdelgawad M, Watkins BM, et al. Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors. Langenbeck's Arch Surg. 2016;401:757–66.CrossRefGoogle Scholar
  20. 20.
    Benedix F, Benedix DD, Knoll C et al. et al. Obesity Surgery Working Group; Competence Network Obesity. Are there risk factors that increase the rate of staple line leakage in patients undergoing primary sleeve gastrectomy for morbid obesity? Obes Surg 2014; 24: 1610–6.Google Scholar
  21. 21.
    Albanopoulos K, Alevizos L, Flessas J, et al. Reinforcing the staple line during laparoscopic sleeve gastrectomy: prospective randomized clinical study comparing two different techniques. Preliminary results. Obes Surg. 2012;22:42–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Choi YY, Bae J, Hur KY, et al. Reinforcing the staple line during laparoscopic sleeve gastrectomy: does it have advantages? A meta-analysis. Obes Surg. 2012;22:1206–13.CrossRefPubMedGoogle Scholar
  23. 23.
    Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8:8–19.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Frank Benedix
    • 1
  • Oliver Poranzke
    • 1
  • Daniele Adolf
    • 2
  • Stephanie Wolff
    • 1
  • Hans Lippert
    • 1
  • Jörg Arend
    • 1
  • Thomas Manger
    • 3
  • Christine Stroh
    • 3
  • Obesity Surgery Working Group Competence Network Obesity
  1. 1.Department of SurgeryUniversity Hospital MagdeburgMagdeburgGermany
  2. 2.StatConsult MagdeburgMagdeburgGermany
  3. 3.SRH Municipal Hospital GeraGeraGermany

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