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Malignant Leakage After Sleeve Gastrectomy: Endoscopic and Surgical Approach

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Abstract

Purpose

Gastric leak occurs after sleeve gastrectomy (SG) in 2% of cases. Most staple-line disruptions (SLD) can be successfully treated with first-line endoscopic procedures. Less favorable situations may lead to more complex therapeutic strategies, like conversion to Roux-en-Y gastric bypass (RYGBP). The aim of our study is to predict the factors of endoscopic treatment failure and to assess the safety of conversion to RYGBP.

Methods

We included all patients treated in two centers of academic excellence (n = 100) between 2013 and 2017 who had a malignant SLD after SG. A “malignant” leakage met one of the following poor prognosis criteria suggested in the literature: unsuccessfully treated by the first-line endoscopic treatment; generalized peritonitis; anatomical anomalies; gastro-cutaneous or gastro-pleural fistula (GCF/GPF); or chronic leaks (> 4 weeks).

Results

No deaths occurred during the follow-up (20 ± 12 months). The endoscopy reported an anatomically abnormal gastric tube in 35 (35%) patients (stenosis [n = 21 (21%)], twist [n = 9 (9%)], or both [n = 5 (5%)]). We could maintain the SG in place in 92% of cases without stenosis, twist, or GCF/GPF. Conversion to RYGBP due to leakage was necessary in 37 (37%) patients. Stenosis, twist, or GCF/GPF significantly prevented healing in multivariate analysis (respectively: p = 0.020, OR = 0.17, and p < 0.001, OR = 0.07—logistic regression).

Conclusion

Endoscopy is the treatment of choice for the management of chronic leaks after SG. The association of anatomical anomalies and GCF/GPF should lead to consideration of conversion to RYGBP.

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Authors and Affiliations

  1. General Endocrine Surgery Department, Lille University Hospital CHU Lille, Lille, France

    Robert Caiazzo, Camille Marciniak, Gregory Baud & François Pattou

  2. EGID-UMR 1190, Translational Research Laboratory for Diabetes, Lille University, Lille, France

    Robert Caiazzo, Camille Marciniak, Gregory Baud & François Pattou

  3. Department of Digestive and Bariatric Surgery, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France

    Ninon Wallach, Jean-Baptiste Cazauran & Maud Robert

  4. General Surgery Department, Roubaix Hospital, Roubaix, France

    Magalie Devienne

  5. Intensive Care Unit, Lille University Hospital CHU Lille, Lille, France

    Eric Kipnis

  6. Gastro Enterology Department, Lille University Hospital CHU Lille, Lille, France

    Julien Branche

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  1. Robert Caiazzo
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  2. Camille Marciniak
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  3. Ninon Wallach
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Correspondence to Robert Caiazzo.

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Conflict of Interest

The authors declare that they have no conflict of interest. Informed consent was obtained from all individual participants included in the study. For this type of study, formal consent is not required.

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Flowchart of the study. (TIFF 2642 kb)

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Caiazzo, R., Marciniak, C., Wallach, N. et al. Malignant Leakage After Sleeve Gastrectomy: Endoscopic and Surgical Approach. OBES SURG 30, 4459–4466 (2020). https://doi.org/10.1007/s11695-020-04818-4

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  • DOI: https://doi.org/10.1007/s11695-020-04818-4

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