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Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients

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Abstract

Introduction

Sleeve gastrectomy has become a popular stand-alone bariatric procedure with comparable weight loss and resolution of comorbidities to that of laparoscopic gastric bypass. The simplicity of the procedure and the decreased long-term risk profile make this surgery more appealing. Nonetheless, the ever present risk of a staple-line leak is still of great concern and needs further investigation.

Methods

An electronic literature search of MEDLINE database plus manual reference checks of articles published on laparoscopic sleeve gastrectomy for morbid obesity and its complications was completed. Keywords used in the search were “sleeve gastrectomy” OR “gastric sleeve” AND “leak.” We analyzed 29 publications, including 4,888 patients. We analyzed the frequency of leak after sleeve gastrectomy and its associated risks of causation.

Results

The risk of leak after sleeve gastrectomy in all comers was 2.4%. This risk was 2.9% in the super-obese [body mass index (BMI) > 50 kg/m2] and 2.2% for BMI < 50 kg/m2. Staple height and use of buttressing material did not affect leak rate. The use of a size 40-Fr or greater bougie was associated with a leak rate of 0.6% compared with those who used smaller sizes whose leak rate was 2.8%. Leaks were found at the proximal third of the stomach in 89% of cases. Most leaks were diagnosed after discharge. Endoscopic management is a viable option for leaks and was documented in 11% of cases as successful.

Conclusions

Sleeve gastrectomy has become an important surgical option for the treatment of the ever growing morbidly obese population. The risk of leak is low at 2.4%. Attention to detail specifically at the esophagogastric junction cannot be stressed enough. Careful patient selection (BMI < 50 kg/m2) and adopting the use of a 40-Fr or larger bougie may decrease the risk of leak. Vigilant follow-up during the first 30 days is critical to avoid catastrophe, because most leaks will happen after patient discharge.

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Disclosures

Dr. Saber is a consultant for Covidian, Baxter, and King Pharmaceutical. Drs. Khaitan and Aurora have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, University Hospitals Case Medical Center, Lakeside 7, 11100 Euclid Avenue, Cleveland, Ohio, 44106, USA

    Alexander R. Aurora, Leena Khaitan & Alan A. Saber

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  1. Alexander R. Aurora
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  2. Leena Khaitan
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  3. Alan A. Saber
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Correspondence to Alan A. Saber.

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Aurora, A.R., Khaitan, L. & Saber, A.A. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc 26, 1509–1515 (2012). https://doi.org/10.1007/s00464-011-2085-3

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  • DOI: https://doi.org/10.1007/s00464-011-2085-3

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