Staple Line Leak Following Laparoscopic Sleeve Gastrectomy

  • Michel Gagner


Staple line leak following laparoscopic sleeve gastrectomy is the most dreaded complication succeeding this operation. Fortunately, it has been declining steadily, and its management is now well organized, so much that the mortality subsequent to this operation is now one of the lowest, making it safer than gastric bypass and full duodenal switch operations. It has grown into the most popular operation in the USA (nearly 60% of all procedures) and also worldwide. Hence, all surgeons should be familiar with the management of this complication, as a function of time and size; there are many methods, ranging from just endoscopy to full-fledged laparoscopic (or open) Roux-en-Y conversions. With its dwindling incidence, it is unlikely that practicing surgeons will acquire enough expertise and experience to treat those, and prevention should be the best policy to avoid them all.


Sleeve gastrectomy Surgical complications Gastric leak Gastric fistula Fistula Stent Weight loss surgery Bariatric surgery 


  1. 1.
    Ali MR, Tichansky DS, Kothari SN, McBride CL, Fernandez AZ Jr, Sugerman HJ, Kellum JM, Wolfe LG, DeMaria EJ. Validation that a 1-year fellowship in minimally invasive and bariatric surgery can eliminate the learning curve for laparoscopic gastric bypass. Surg Endosc. 2010;24(1):138–44.PubMedCrossRefGoogle Scholar
  2. 2.
    Al Hajj G, Chemaly R. Fistula following laparoscopic sleeve gastrectomy: a proposed classification and algorithm for optimal management. Obes Surg. 2018;28(3):656–64.CrossRefGoogle Scholar
  3. 3.
    Aryaie AH, Singer JL, Fayezizadeh M, Lash J, Marks JM. Efficacy of endoscopic management of leak after foregut surgery with endoscopic covered self-expanding metal stents (SEMS). Surg Endosc. 2017;31(2):612–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Baltasar A, Bou R, Miro J, Bengochea M, Serra C, Pérez N. Laparoscopic biliopancreatic diversion with duodenal switch: technique and initial experience. Obes Surg. 2002;12:245–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Baltasar A, Serra C, Pérez N, Bou R, Bengoechea M. Re-sleeve gastrectomy. Obes Surg. 2006;16:1535–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Baltasar A, Bou R, Bengochea M, Serra C, Cipagauta L. Use of a Roux limb to correct esophagogastric junction fistulas after sleeve gastrectomy. Obes Surg. 2007;17:1408–10.PubMedCrossRefGoogle Scholar
  7. 7.
    Barreto TW, Kemmeter PR, Paletta MP, Davis AT. A comparison of a single center's experience with three staple line reinforcement techniques in 1,502 laparoscopic sleeve gastrectomy patients. Obes Surg. 2015;25(3):418–22CrossRefGoogle Scholar
  8. 8.
    Baretta G, Campos J, Correia S, Alhinho H, Marchesini JB, Lima JH, Neto MG. Bariatric postoperative fistula: a life-saving endoscopic procedure. Surg Endosc. 2015;29(7):1714–20.PubMedCrossRefGoogle Scholar
  9. 9.
    Bège T, Emungania O, Vitton V, Ah-Soune P, Nocca D, Noël P, Bradjanian S, Berdah SV, Brunet C, Grimaud JC, Barthet M. An endoscopic strategy for management of anastomotic complications from bariatric surgery: a prospective study. Gastrointest Endosc. 2011;73(2):238–44.PubMedCrossRefGoogle Scholar
  10. 10.
    Bellanger DE, Greenway FL. Laparoscopic sleeve gastrectomy, 529 cases without a leak: short-term results and technical considerations. Obes Surg. 2011;21(2):146–50.PubMedCrossRefGoogle Scholar
  11. 11.
    Benedix F, Benedix DD, Knoll C, Weiner R, Bruns C, Manger T, et al. 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.PubMedCrossRefGoogle Scholar
  12. 12.
    Benedix F, Poranzke O, Adolf D, Wolff S, Lippert H, Arend J, Manger T, Stroh C. Obesity surgery working group competence network obesity. Staple line leak after primary sleeve gastrectomy-risk factors and mid-term results: do patients still benefit from the weight loss procedure? Obes Surg. 2017;27(7):1780–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Benotti P, Forse RA. Safety and long-term efficacy of revisional surgery in severe obesity. Am J Surg. 1996;172:232–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Berger ER, Huffman KM, Fraker T, Petrick AT, Brethauer SA, Hall BL, Ko CY, Morton JM. Prevalence and risk factors for bariatric surgery readmissions: findings from 130,007 admissions in the metabolic and bariatric surgery accreditation and quality improvement program. Ann Surg. 2018;267(1):122–31.PubMedCrossRefGoogle Scholar
  15. 15.
    Boeker C, Mall J, Reetz C, Yamac K, Wilkens L, Stroh C, Koehler H. Laparoscopic sleeve gastrectomy: investigation of fundus wall thickness and staple height-an observational cohort study : fundus wall thickness and leaks. Obes Surg. 2017. [Epub ahead of print].Google Scholar
  16. 16.
    Bouchard S, Eisendrath P, Toussaint E, Le Moine O, Lemmers A, Arvanitakis M, Devière J. Trans-fistulary endoscopic drainage for post-bariatric abdominal collections communicating with the upper gastrointestinal tract. Endoscopy. 2016;48(9):809–16.PubMedCrossRefGoogle Scholar
  17. 17.
    Brethauer SA, Pryor AD, Chand B, Schauer P, Rosenthal R, Richards W et al. Endoluminal procedures for bariatric patients: expectations among bariatric surgery. Surg Obes Relat Dis. 2009;5(2):231–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Brownlee A, Bromberg E, Roslin M. Outcomes in patients with helicobacter pylori undergoing laparoscopic sleeve gastrectomy. Obes Surg. 2015;25:2276–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Bruzzi M, Douard R, Voron T, Berger A, Zinzindohoue F, Chevallier JM. Open total gastrectomy with Roux-en-Y reconstruction for a chronic fistula after sleeve gastrectomy. Surg Obes Relat Dis. 2016;12(10):1803–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–36.PubMedCrossRefGoogle Scholar
  21. 21.
    Burgos AM, Braghetto I, Csendes A, Maluenda F, Korn O, Yarmuch J, et al. Gastric leak after laparoscopic-sleeve gastrectomy for obesity. Obes Surg. 2009;19(12):1672–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Campos JM, Pereira EF, Evangelista LF, et al. Gastrobronchial fistula after sleeve gastrectomy and gastric bypass: endoscopic management and prevention. Obes Surg. 2011;21(10):1520–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Campos JM, Ferreira FC, Teixeira AF, Lima JS, Moon RC, D'Assunção MA, Neto MG. Septotomy and balloon dilation to treat chronic leak after sleeve gastrectomy: technical principles. Obes Surg. 2016;26(8):1992–3.PubMedCrossRefGoogle Scholar
  24. 24.
    Cesana G, Cioffi S, Giorgi R, Villa R, Uccelli M, Ciccarese F, Castello G, Scotto B, Olmi S. Proximal leakage after laparoscopic sleeve gastrectomy: an analysis of preoperative and operative predictors on 1738 consecutive procedures. Obes Surg. 2018;28(3):627–35.CrossRefGoogle Scholar
  25. 25.
    Chouillard E, Younan A, Alkandari M, Daher R, Dejonghe B, Alsabah S, Biagini J. Roux-en-Y fistulo-jejunostomy as a salvage procedure in patients with post-sleeve gastrectomy fistula: mid-term results. Surg Endosc. 2016;30(10):4200–4.PubMedCrossRefGoogle Scholar
  26. 26.
    Clinical Issues Committee of American Society for Metabolic and Bariatric Surgery. Sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis. 2007;3:573–6.CrossRefGoogle Scholar
  27. 27.
    Conio M, Blanchi S, Repici A, Bastardini R, Marinari GM. Use of an over-the scope clip for endoscopic sealing of a gastric fistula after sleeve gastrectomy. Endoscopy. 2010;42(Suppl 2):E71–2.PubMedCrossRefGoogle Scholar
  28. 28.
    Consten EC, Dakin GF, Gagner M. Intraluminal migration of bovine pericardial strips used to reinforced the gastric staple-line in laparoscopic bariatric surgery. Obes Surg. 2004;14:549–54.PubMedCrossRefGoogle Scholar
  29. 29.
    Consten EC, Gagner M, Pomp A, Inabnet W. Decreased bleeding after laparoscopic sleeve gastrectomy with or without duodenal switch for morbid obesity using a stapled buttressed absorbable polymer membrane. Obes Surg. 2004;14:1360–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Consten EC, Gagner M. Staple-line reinforcement techniques with different buttressing materials used for laparoscopic gastrointestinal surgery: a new strategy to diminish perioperative complications. Surg Technol Int. 2004;13:59–63.PubMedGoogle Scholar
  31. 31.
    Cuadrado Ayuso M Franco Herrera R, Lago Oliver J. Successful management of laparoscopic sleeve gastrectomy leak with negative pressure therapy. Obes Surg. 2017. [Epub ahead of print].Google Scholar
  32. 32.
    Csendes A, Braghetto I, Leon P, et al. Management of leaks after laparoscopic sleeve gastrectomy in patients with obesity. J Gastrointest Surg. 2010;14(9):1343–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Daskalakis M, Berdan Y, Theodoridou S, et al. Impact of surgeon experience and buttress material on postoperative complications after laparoscopic sleeve gastrectomy. Surg Endosc. 2011;25(1):88–97.PubMedCrossRefGoogle Scholar
  34. 34.
    De Angelis F, Abdelgawad M, Rizzello M, Mattia C, Silecchia G. Perioperative hemorrhagic complications after laparoscopic sleeve gastrectomy: four-year experience of a bariatric center of excellence. Surg Endosc. 2016. [Epub ahead of print].Google Scholar
  35. 35.
    Dolan K, Hatzifotis M, Newbury L, Lowe N, Fielding G. A clinical and nutritional comparison of biliopancreatic diversion with and without duodenal switch. Ann Surg. 2004;240:51–6.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    D’Ugo S, Gentileschi P, Benavoli D, Cerci M, Gaspari A, Berta RD, et al. Comparative use of different techniques for leak and bleeding prevention during laparoscopic sleeve gastrectomy: a multicenter study. Surg Obes Relat Dis. 2014;10(3):450–4.PubMedCrossRefGoogle Scholar
  37. 37.
    Edwards CA, Bui TP, Astudillo JA, et al. Management of anastomotic leaks after Roux-en-Y bypass using self-expanding polyester stents. Surg Obes Relat Dis. 2008;4:594–9. discussion 599–600PubMedCrossRefGoogle Scholar
  38. 38.
    Eisendrath P, Cremer M, Himpens J, Cadière GB, Le Moine O, Devière J. Endotherapy including temporary stenting of fistulas of the upper gastrointestinal tract after laparoscopic bariatric surgery. Endoscopy. 2007;39:625–30.PubMedCrossRefGoogle Scholar
  39. 39.
    Elariny H, Gonzalez H, Wang B. Tissue thickness of human stomach measured on excised gastric specimens from obese patients. Surg Technol Int. 2005;14:119–24.PubMedGoogle Scholar
  40. 40.
    Ellens NR, Simon JE, Kemmeter KD, Barreto TW, Kemmeter PR. Evaluating the feasibility of phrenoesophagopexy during hiatal hernia repair in sleeve gastrectomy patients. Surg Obes Relat Dis. 2017;13(12):1952–6.PubMedCrossRefGoogle Scholar
  41. 41.
    El Mourad H, Himpens J, Verhofstadt J. Stent treatment for fistula after obesity surgery: results in 47 consecutive patients. Surg Endosc. 2013;27(3):808–16.PubMedCrossRefGoogle Scholar
  42. 42.
    Eubanks S, Edwards CA, Fearing NM, Ramaswamy A, de la Torre RA, Thaler KJ, et al. Use of endoscopic stents to treat anastomotic complications after bariatric surgery. J Am Coll Surg. 2008;206:935–8.PubMedCrossRefGoogle Scholar
  43. 43.
    Fezzi M, Kolotkin RL, Nedelcu M, et al. Improvement in quality of life after laparoscopic sleeve gastrectomy. Obes Surg. 2011;21(8):1161–7.PubMedCrossRefGoogle Scholar
  44. 44.
    Froylich D, Corcelles R, Davis M, Boules M, Daigle CR, Schauer PR, Brethauer SA. Factors associated with length of stay in intensive care after bariatric surgery. Surg Obes Relat Dis. 2016;12(7):1391–6.PubMedCrossRefGoogle Scholar
  45. 45.
    Fukumoto R, Orlina J, McGinty J, Teixeira J. Use of polyflex stents in treatment of acute esophageal and gastric leaks after bariatric surgery. Surg Obes Relat Dis. 2007;3:68–72.PubMedCrossRefGoogle Scholar
  46. 46.
    Gagner M, Rogula T. Laparoscopic reoperative sleeve gastrectomy for poor weight loss after biliopancreatic diversion with duodenal switch. Obes Surg. 2003;13:649–54.PubMedCrossRefGoogle Scholar
  47. 47.
    Gagner M. Meta-analysis of leaks following laparoscopic vertical sleeve gastrectomy. Obes Surg. 2011;21(8):958. Abstract PL02-05; presented at the XVI World Congress of International Federation of the Surgery of Obesity (IFSO), Aug 31-Sept 3, 2011, Hamburg, GermanyGoogle Scholar
  48. 48.
    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.PubMedCrossRefGoogle Scholar
  49. 49.
    Gagner M, Buchwald J. Comparison of laparoscopic sleeve gastrectomy leak rates in four staple-line reinforcement options: a systematic review. Surg Obes Relat Dis. 2014;10(4):713–23.PubMedCrossRefGoogle Scholar
  50. 50.
    Gagner M, Brown M. Update on sleeve gastrectomy leak rate with the use of reinforcement. Obes Surg. 2016;26:146–50.PubMedCrossRefGoogle Scholar
  51. 51.
    Garofalo F, Noreau-Nguyen M, Denis R, Atlas H, Garneau P, Pescarus R. Evolution of endoscopic treatment of sleeve gastrectomy leaks: from partially covered to long, fully covered stents. Surg Obes Relat Dis. 2017;13(6):925–32.PubMedCrossRefGoogle Scholar
  52. 52.
    Geubbels N, de Brauw LM, Acherman YI, van de Laar AW, Wouters MW, Bruin SC. The preceding surgeon factor in bariatric Surgery: a positive influence on the learning curve of subsequent surgeons. Obes Surg. 2014. [Epub ahead of print].Google Scholar
  53. 53.
    Guerron AD, Ortega CB, Portenier D. Endoscopic abscess septotomy for management of sleeve gastrectomy leak. Obes Surg. 2017. [Epub ahead of print]
  54. 54.
    Hess DS, Hess DW. Biliopancreatic diversion with a duodenal switch. Obes Surg. 1998;8:267–82.PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Hess DS, Hess DW, Oakley R. The biliopancreatic diversion with the duodenal switch: results beyond 10 years. Obes Surg. 2005;15:408–16.PubMedCrossRefGoogle Scholar
  56. 56.
    Huang R, Gagner M. A thickness calibration device is needed to determine staple height and avoid leaks in laparoscopic sleeve gastrectomy. Obes Surg. 2015;25:2360–7.PubMedPubMedCentralCrossRefGoogle Scholar
  57. 57.
    Hussain A, Vasas P, Kirk K, Finney J, Balchandra S. Etiology of leaks following sleeve gastrectomy: current evidence. Surg Laparosc Endosc Percutan Tech. 2017;27(3):119–22.PubMedCrossRefGoogle Scholar
  58. 58.
    Iannelli A, Tavana R, Martini F, Noel P, Gugenheim J. Laparoscopic roux limb placement over a fistula defect without mucosa-to-mucosa anastomosis: a modified technique for surgical management of chronic proximal fistulas after laparoscopic sleeve gastrectomy. Obes Surg. 2014;24(5):825–8.PubMedCrossRefGoogle Scholar
  59. 59.
    Iossa A, Abdelgawad M, Watkins BM, Silecchia G. Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors. Langenbeck’s Arch Surg. 2016;401(6):757–66.CrossRefGoogle Scholar
  60. 60.
    Jacobsen GR, Coker AM, Acosta G, Talamini MA, Savides TJ, Horgan S. Initial experience with an innovative endoscopic clipping system. Surg Technol Int. 2012;22:39–43.PubMedGoogle Scholar
  61. 61.
    Kauer WK, Stein HJ, Dittler HJ, Siewert JR. Stent implantation as a treatment option in patients with thoracic anastomotic leaks after esophagectomy. Surg Endosc. 2008;22:50–3.PubMedCrossRefGoogle Scholar
  62. 62.
    Kim WW, Gagner M, Kini S, Inabnet WB, Quinn T, Herron D, Pomp A. Laparoscopic vs. open biliopancreatic diversion with duodenal switch: a comparative study. J Gastrointest Surg. 2003;7:552–7.PubMedCrossRefGoogle Scholar
  63. 63.
    Kowalski C, Kastuar S, Mehta V, Brolin R. Endoscopic injection of fibrin sealant in repair of gastrojejunostomy leak after laparoscopic Roux-en Y gastric bypass. Surg Obes Relat Dis. 2007;3:438–42.PubMedCrossRefGoogle Scholar
  64. 64.
    Kriwanek S, Ott N, Ali-Abdullah S, Pulgram T, Tscherney R, Reiter M, Roka R. Treatment of gastro-jejunal leakage and fistulization after gastric bypass with coated self-expanding stents. Obes Surg. 2006;16:1669–74.PubMedCrossRefGoogle Scholar
  65. 65.
    Lazzati A, Guy-Lachuer R, Delaunay V, Szwarcensztein K, Azoulay D. Bariatric surgery trends in France: 2005–2011. Surg Obes Relat Dis. 2014;10(2):328–34.PubMedCrossRefGoogle Scholar
  66. 66.
    Leeds SG, Burdick JS. Management of gastric leaks after sleeve gastrectomy with endoluminal vacuum (E-Vac) therapy. Surg Obes Relat Dis. 2016;12(7):1278–85.PubMedCrossRefGoogle Scholar
  67. 67.
    Lindenmann J, Matzi V, Porubsky C, Anegg U, Sankin O, Gabor S, et al. Self-expandable covered metal tracheal type stent for sealing cervical anastomotic leak after esophagectomy and gastric pull-up: pitfalls and possibilities. Ann Thorac Surg. 2008;85:354–6.PubMedCrossRefGoogle Scholar
  68. 68.
    Mahadev S, Kumbhari V, Campos JM, Galvao Neto M, Khashab MA, Chavez YH, Bessler M, Gonda TA. Endoscopic septotomy: an effective approach for internal drainage of sleeve gastrectomy-associated collections. Endoscopy. 2017;49(5):504–8.PubMedCrossRefGoogle Scholar
  69. 69.
    Maluf-Filho F, Lima MS, Hondo F. Endoscopic placement of a “plug” made of acellular biomaterial: a new technique for the repair of gastric leak after Roux-en-Y gastric bypass. Arq Gastroenterol. 2008;45:208–1.PubMedCrossRefGoogle Scholar
  70. 70.
    Marceau P, Hould FS, Simard S, Lebel S, Bourque RA, Potvin M, Biron. Biliopancreatic diversion with duodenal switch. World J Surg. 1998;22:947–54.PubMedCrossRefGoogle Scholar
  71. 71.
    Marquez M, Ayza Ferrer M, Belda LR, del Mar Rico Morales M, Diez JM, Belda Poujoulet R. Gastric leak after laparoscopic sleeve gastrectomy. Obes Surg. 2010;20:1306–11.PubMedCrossRefGoogle Scholar
  72. 72.
    Mejía AF, Bolaños E, Chaux CF, Unigarro I. Endoscopic treatment of gastrocutaneous fistula following gastric bypass for obesity. Obes Surg. 2007;17:544–6.PubMedCrossRefGoogle Scholar
  73. 73.
    Montuori M, Benavoli D, D'Ugo S, Di Benedetto L, Bianciardi E, Gaspari AL, Gentileschi P. Integrated approaches for the management of staple line leaks following sleeve gastrectomy. J Obes. 2017;2017:4703236. Epub 2017 Feb 2PubMedPubMedCentralCrossRefGoogle Scholar
  74. 74.
    Trelles N, Gagner M, Palermo M, Pomp A, Dakin G, Parikh M. Gastrocolic fistula after re-sleeve gastrectomy: outcomes after esophageal stent implantation. Surg Obes Relat Dis. 2010;6(3):308–12.PubMedCrossRefGoogle Scholar
  75. 75.
    Nedelcu M, Manos T, Cotirlet A, Noel P, Gagner M. Outcome of leaks after sleeve gastrectomy based on a new algorithm addressing leak size and gastric stenosis. Obes Surg. 2015;25(3):559–63.PubMedCrossRefGoogle Scholar
  76. 76.
    Nedelcu M, Skalli M, Delhom E, Fabre JM, Nocca D. New CT scan classification of leak after sleeve gastrectomy. Obes Surg. 2013;23(8):1341–3.PubMedCrossRefGoogle Scholar
  77. 77.
    Nedelcu AM, Skalli M, Deneve E, Fabre JM, Nocca D. Surgical management of chronic fistula after sleeve gastrectomy. Surg Obes Relat Dis. 2013;9(6):879–84.PubMedCrossRefGoogle Scholar
  78. 78.
    Nedelcu M, Manos T, Gagner M, Eddbali I, Ahmed A, Noel P. Cost analysis of leak after sleeve gastrectomy. Surg Endosc. 2017. [Epub ahead of print]
  79. 79.
    Nedelcu M, Noel P. Paired editorial: evolution of endoscopic treatment of sleeve gastrectomy leaks: from partially covered to long fully covered stents. Surg Obes Relat Dis. 2017;13(6):933.PubMedCrossRefGoogle Scholar
  80. 80.
    Nguyen NT, Longoria M, Chalifoux S, Wilson SE. Bioabsorbable staple line reinforcement for laparoscopic gastrointestinal surgery. Surg Technol Int. 2005;14:107–11.PubMedGoogle Scholar
  81. 81.
    Nguyen NT, Longoria M, Welbourne S, Savio A, Wilson S. Glycolide copolymer staple line reinforcement reduces staple site bleeding during laparoscopic gastric bypass. A prospective randomized trial. Arch Surg. 2005;140:773–8.PubMedCrossRefGoogle Scholar
  82. 82.
    Nguyen NT, Vu S, Kim E, Bodunova N, et al. Trends in utilization of bariatric surgery, 2009–2012. Surg Endosc. 2016;30:3723–7.Google Scholar
  83. 83.
    Noel P, Iannelli A, Sejor E, Schneck AS, Gugenheim J. Laparoscopic sleeve gastrectomy: how I do it. Surg Laparosc Endosc Percutan Tech. 2013;23(1):e14–6.PubMedCrossRefGoogle Scholar
  84. 84.
    Noel P, Schneck A, Nedelcu M, Lee J, et al. Laparoscopic sleeve gastrectomy as a revisional procedure for failed gastric banding: lessons from 300 consecutive cases. Surg Obes Relat Dis. 2014;10:1166–22.CrossRefGoogle Scholar
  85. 85.
    Noel P, Nedelcu M, Gagner M. Impact of the surgical experience on leak rate after laparoscopic sleeve gastrectomy. Obes Surg. 2016;26(8):1782–7.CrossRefGoogle Scholar
  86. 86.
    Nowakowski P, Ziaja K, Ludyga T, Kuczmik W, Biolik G, Cwik P, et al. Self-expandable metallic stents in the treatment of post-esophagogastrostomy/post-esophagoenterostomy fistula. Dis Esophagus. 2007;20:358–60.PubMedCrossRefGoogle Scholar
  87. 87.
    Obeid N, Schwack B, Kurian M, Ren-Fielding C, et al. Single-stage versus 2-stage sleeve gastrectomy as a conversion after failed adjustable gastric banding: 30-day outcomes. Surg Endosc. 2014;28:3186–92.PubMedCrossRefGoogle Scholar
  88. 88.
    Papavramidis ST, Eleftheriadis EE, Papavramidis TS, Kotzampassi KE, Gamvros OG. Endoscopic management of gastrocutaneous fistula after bariatric surgery by using fibrin sealant. Gastrointest Endosc. 2004;59:296–300.PubMedCrossRefGoogle Scholar
  89. 89.
    Papavramidis TS, Kotzampassi K, Kotidis E, Eleftheriadis EE, Papavramidis ST. Endoscopic fibrin sealing of gastrocutaneous fistulas after sleeve gastrectomy and biliopancreatic diversion with duodenal switch. J Gastroenterol Hepatol. 2008;23:1802–5.PubMedCrossRefGoogle Scholar
  90. 90.
    Parikh M, Issa R, McCrillis A, Saunders JK, Ude-Welcome A, Gagner M. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg. 2013;257(2):231–7.PubMedCrossRefGoogle Scholar
  91. 91.
    Patel RA, Brolin RE, Gandhi A. Revisional operations for marginal ulcer after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2009;5(3):317–22.PubMedCrossRefGoogle Scholar
  92. 92.
    Peker KD, Sahbaz NA, Seyit H, Kones O, Gumusoglu AY, Alis H. An alternative view on the necessity of EGD before sleeve gastrectomy. Surg Obes Relat Dis. 2017;13(12):1959–64.PubMedCrossRefGoogle Scholar
  93. 93.
    Pequignot A, Fuks D, Verhaeghe P, Dhahri A, Brehant O, Bartoli E, Delcenserie R, Yzet T, Regimbeau JM. Is there a place for pigtail drains in the management of gastric leaks after laparoscopic sleeve gastrectomy? Obes Surg. 2012;22(5):712–20.PubMedCrossRefGoogle Scholar
  94. 94.
    Perez M, Brunaud L, Kedaifa S, Guillotin C, et al. Does anatomy explain the origin of a leak after sleeve gastrectomy? Obes Surg. 2014;24:1717–23.PubMedCrossRefGoogle Scholar
  95. 95.
    Prachand VN, Davee RT, Alverdy JC. Duodenal switch provides superior weight loss in the super-obese (BMI > or = 50 kg/m2) compared with gastric bypass. Ann Surg. 2006;244:611–9.PubMedPubMedCentralGoogle Scholar
  96. 96.
    Puli SR, Spofford IS, Thompson CC. Use of self-expandable stents in the treatment of bariatric surgery leaks: a systematic review and meta-analysis. Gastrointest Endosc. 2012;75(2):287–93.PubMedCrossRefGoogle Scholar
  97. 97.
    Rebibo L, Delcenserie R, Brazier F, Yzet T, Regimbeau JM. Treatment of gastric leaks after sleeve gastrectomy. Endoscopy. 2016;48(6):590.PubMedCrossRefGoogle Scholar
  98. 98.
    Rebibo L, Hakim S, Brazier F, Dhahri A, Cosse C, Regimbeau JM. New endoscopic technique for the treatment of large gastric fistula or gastric stenosis associated with gastric leaks after sleeve gastrectomy. Surg Obes Relat Dis. 2016;12(8):1577–84.PubMedCrossRefGoogle Scholar
  99. 99.
    Regan JP, Inabnet WB, Gagner M, Pomp A. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg. 2003;13:861–4.PubMedCrossRefGoogle Scholar
  100. 100.
    Ren CJ, Patterson E, Gagner M. Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients. Obes Surg. 2000;10:514–24.PubMedCrossRefGoogle Scholar
  101. 101.
    Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, Arvidsson D, Baker RS, Basso N, Bellanger D, Boza C, El Mourad H, France M, Gagner M, Galvao-Neto M, Higa KD, Himpens J, Hutchinson CM, Jacobs M, Jorgensen JO, Jossart G, Lakdawala M, Nguyen NT, Nocca D, Prager G, Pomp A, Ramos AC, Rosenthal RJ, Shah S, Vix M, Wittgrove A, Zundel N. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8(1):8–19.PubMedPubMedCentralCrossRefGoogle Scholar
  102. 102.
    Sakran N, Goitein D, Raziel A, Keidar A, Beglaibter N, Grinbaum R, Matter I, Alfici R, Mahajna A, Waksman I, Shimonov M, Assalia A. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2013;27(1):240–5.PubMedCrossRefGoogle Scholar
  103. 103.
    Scopinaro N, Adami GF, Marinari GM. Biliopancreatic diversion: two decades of experience. In: Deitel M, editor. Update: surgery for the morbidly obese patient. Toronto: FD-Communications; 2000. p. 227–58.Google Scholar
  104. 104.
    Serra C, Baltasar A, Andreo L, Pérez N, Bou R, Bengochea M, Chisbert J. Treatment of gastric leaks with self-expanding stents after sleeve gastrectomy. Obes Surg. 2007;17:866–72.PubMedCrossRefGoogle Scholar
  105. 105.
    Ueda K, Gagner M, Milone L, Bardaro S, Gong K. Sleeve gastrectomy with wrapping using polytetrafluoroethylene to prevent gastric enlargement in a porcine model. Surg Obes Relat Dis. 2008;4:84–90.PubMedCrossRefGoogle Scholar
  106. 106.
    Saglam K, Aktas A, Gundogan E, Ertugrul I, Tardu A, Karagul S, Kirmizi S, Sumer F, Ersan V, Kayaalp C. Management of acute sleeve gastrectomy leaks by conversion to Roux-en-Y gastric bypass: a small case series. Obes Surg. 2017;27(11):3061–3.PubMedCrossRefGoogle Scholar
  107. 107.
    Salinas A, Baptista A, Santiago E, Antor M, Salinas H. Self-expandable metal stents to treat gastric leaks. Surg Obes Relat Dis. 2006;2(5):570–2.PubMedCrossRefGoogle Scholar
  108. 108.
    Sanchez-Santos R, Masdevall C, Baltasar A, et al. Short and mid-term outcomes of sleeve gastrectomy for morbid obesity: the experience of the Spanish National Registry. Obes Surg. 2009;19:1203–10.PubMedCrossRefGoogle Scholar
  109. 109.
    Ser KH, Lee WJ, Lee YC, et al. Experience in laparoscopic sleeve gastrectomy for morbidly obese Taiwanese: staple-line reinforcement is important for preventing leakage. Surg Endosc. 2010;24(9):2253–9.PubMedCrossRefGoogle Scholar
  110. 110.
    Serra C, Baltasar A, Andreo L. Treatment of gastric leaks with coated self-expanding stents after sleeve gastrectomy. Obes Surg. 2007;17:866–72.PubMedCrossRefGoogle Scholar
  111. 111.
    Shehab H, Abdallah E, Gawdat K, Elattar I. Large bariatric-specific stents and over-the-scope clips in the Management of Post-Bariatric Surgery Leaks. Obes Surg. 2018;28(1):15–24.CrossRefGoogle Scholar
  112. 112.
    Shikora SA, Kim JJ, Tarnoff ME. Reinforcing gastric staple lines with bovine pericardial strips may decrease the likelihood of gastric leak after laparoscopic roux-en-Y gastric bypass. Obes Surg. 2003;13:37–44.PubMedCrossRefGoogle Scholar
  113. 113.
    Shikora S, Mahoney C. Clinical benefit of gastric staple line reinforcement (SLR) in gastrointestinal surgery: a meta-analysis. Obes Surg. 2015;25:1133–41.PubMedPubMedCentralCrossRefGoogle Scholar
  114. 114.
    Shnell M, Gluck N, Abu-Abeid S, Santo E, Fishman S. Use of endoscopic septotomy for the treatment of late staple-line leaks after laparoscopic sleeve gastrectomy. Endoscopy. 2017;49(1):59–63.PubMedGoogle Scholar
  115. 115.
    Shoar S, Poliakin L, Khorgami Z, Rubenstein R, El-Matbouly M, Levin JL, Saber AA. Efficacy and safety of the over-the-scope clip (OTSC) system in the Management of Leak and Fistula after laparoscopic sleeve gastrectomy: a systematic review. Obes Surg. 2017;27(9):2410–18.PubMedCrossRefGoogle Scholar
  116. 116.
    Simon F, Siciliano I, Gillet A, Castel B, Coffin B, Msika S. Gastric leak after laparoscopic sleeve gastrectomy: early covered self-expandable stent reduces healing time. Obes Surg. 2013;23(5):687–92.PubMedCrossRefGoogle Scholar
  117. 117.
    Sporn E, Miedema BW, Astudillo JA, Thaler K. Lessons learned establishing an animal model for endoscopic stent placement to treat gastrojejunal anastomotic leaks after Gastric bypass. Obes Surg. 2009;19(8):1163–9.PubMedCrossRefGoogle Scholar
  118. 118.
    Strain GW, Gagner M, Inabnet WB, Dakin G, Pomp A. Comparison of effects of gastric bypass and biliopancreatic diversion with duodenal switch on weight loss and body composition 1–2 years after surgery. Surg Obes Relat Dis. 2007;3:31–6.PubMedCrossRefGoogle Scholar
  119. 119.
    Stroh C, Kockerling F, Volker L, Frank B, et al. Results of more than 11,800 sleeve gastrectomies: data analysis of the German Bariatric Surgery Registry. Ann Surg. 2016;263:949–55.PubMedCrossRefGoogle Scholar
  120. 120.
    Surace M, Mercky P, Demarquay JF, Gonzalez JM, Dumas R, Ah-Soune P, et al. Endoscopic management of GI fistulae with over-the-scope clip system. Gastrointest Endosc. 2011;74(6):1416–9.PubMedCrossRefGoogle Scholar
  121. 121.
    Swinnen J, Eisendrath P, Rigaux J, Kahegeshe L, Lemmers A, Le Moine O, Devière J. Self-expandable metal stents for the treatment of benign upper GI leaks and perforations. Gastrointest Endosc. 2011;73(5):890–9.PubMedCrossRefGoogle Scholar
  122. 122.
    Tan TJ, Kariyawasam S, Wijeratne T, Chandraratna S. Diagnosis and management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg. 2010;20:403–9.PubMedCrossRefGoogle Scholar
  123. 123.
    Tavenor T, Smith S, Sullivan S. Gastrocolic fistula – a review of 15 cases and an update of the literature. J Clin Gastroenterol. 1993;16:189–91.PubMedCrossRefGoogle Scholar
  124. 124.
    Thomopoulos T, Thoma M, Navez B. Roux-En-Y Fistulojejunostomy: a new therapeutic option for complicated post-sleeve gastric fistulas, video-report. Obes Surg. 2017;27(6):1638–9.PubMedCrossRefGoogle Scholar
  125. 125.
    Trelles N, Gagner M. Sleeve gastrectomy. In: Koltun WA, editor. Operatives techniques in general surgery, vol. 9. Hershey: Elsevier; 2007. p. 123–31.Google Scholar
  126. 126.
    Tringali A, Bove V, Perri V, Landi R, Familiari P, Boškoski I, Costamagna G. Endoscopic treatment of post-laparoscopic sleeve gastrectomy leaks using a specifically designed metal stent. Endoscopy. 2017;49(1):64–8.PubMedGoogle Scholar
  127. 127.
    Varban OA, Sheetz KH, Cassidy RB, Stricklen A, Carlin AM, Dimick JB, Finks JF. Evaluating the effect of operative technique on leaks after laparoscopic sleeve gastrectomy: a case-control study. Surg Obes Relat Dis. 2017;13(4):560–7.PubMedCrossRefGoogle Scholar
  128. 128.
    Villalba MR, Villalba MR. Development of a gastric pouch-aorto-colic fistula as a complication of a revisionary open Roux-en-Y gastric bypass. Obes Surg. 2009;19:265–8. Epub 2008PubMedCrossRefGoogle Scholar
  129. 129.
    Weiner RA, Weiner S, Pomhoff I, Jacobi C, Makarewicz W, Weigand G. Laparoscopic sleeve gastrectomy-influence of sleeve size and resected gastric volume. Obes Surg. 2007;17:1297–305.PubMedCrossRefGoogle Scholar
  130. 130.
    Wright A, Chang A, Bedi AO, Wansteker EJ, Elta G, Kwon RS, Carrott P, Elmunzer BJ, Law R. Endoscopic suture fixation is associated with reduced migration of esophageal fully covered self-expandable. Surg Endosc. 2017;31:3489–94.PubMedCrossRefGoogle Scholar
  131. 131.
    Yehoshua RT, Eidelman LA, Stein M, Fichman S, Mazor A, Chen J, et al. Laparoscopic sleeve gastrectomy – volume and pressure assessment. Obes Surg. 2008;18:1083–8.PubMedCrossRefGoogle Scholar
  132. 132.
    Yo LS, Consten EC, Quarles van Ufford HM, Gooszen HG, Gagner M. Buttressing of the staple line in gastrointestinal anastomoses: overview of new technology designed to reduce perioperative complications. Dig Surg. 2006;23:283–91.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Michel Gagner
    • 1
    • 2
  1. 1.Professor of Surgery, Department of Surgery, Herbert Wertheim School of MedicineFlorida International UniversityMiamiUSA
  2. 2.Department of SurgeryHôpital Du Sacré CoeurMontréalCanada

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