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Leaks and Fistulas After Sleeve Gastrectomy

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The Perfect Sleeve Gastrectomy

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Abstract

Sleeve gastrectomy (LSG) is safe and effective, but not without complications, two of them, postoperative leaks and hemorrhage in the stapling line, are the most feared. Leaks are more frequent with rates between 0.75% and 3%. It is a serious complication, it is the second cause of death after bariatric surgery with a mortality rate between 0% and 1.4%. Generally of late presentation and in the form of peritoneal and / or systemic infections. They require invasive treatments such as surgeries, drains or stents with prolonged stays and great economic impact. To prevent them, according to the evidence and consensus of experts, use bougie size ≥40 Fr. Start gastric transection 5 cm from the pylorus. Stay at least 1 cm from the angle of His. Use the correct cartridges. Symmetry of the stapling line. Proper stomach traction before stapling. Strengthen the stapling line and control the bleeding of the staple line.

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References

  1. Al-Kurd A, Grinbaum R, Abubeih A, Verbner A, Kupietzky A, Mizrahi I, Mazeh H, Beglaibter N. Not all leaks are created equal: a comparison between leaks after sleeve gastrectomy and Roux-En-Y gastric bypass. Obes Surg. 2018;28(12):3775–82. https://doi.org/10.1007/s11695-018-3409-3.

    Article  PubMed  Google Scholar 

  2. Jurowich C, Thalheimer A, Seyfried F, et al. Gastric leakage after sleeve gastrectomy-clinical presentation and therapeutic options. Langenbeck’s Arch Surg. 2011;396(7):981–7.

    Article  Google Scholar 

  3. Bransen J, Gilissen LP, van Rutte PW, Nienhuijs SW. Costs of leaks and bleeding after sleeve gastrectomies. Obes Surg. 2015;25(10):1767–71.

    Article  Google Scholar 

  4. Ahmed A, Adamo M, Balchandra S. The real costs of treating early post-operative leaks following sleeve gastrectomy procedures. Obes Surg. 2015;25(Suppl 1):S45–O144.

    Google Scholar 

  5. 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. https://doi.org/10.1007/s11695-017-2907-z.

    Article  PubMed  Google Scholar 

  6. Baker RS, Foote J, Kemmeter P, Brady R, Vroegop T, Serveld M. The science of stapling and leaks. Obes Surg. 2004;14(10):1290–8.

    Article  Google Scholar 

  7. Yehoshua RT, Eidelman LA, Stein M, et al. Laparoscopic sleeve gastrectomy–volume and pressure assessment. Obes Surg. 2008;18(9):1083–8.

    Article  Google Scholar 

  8. Mion F, Tolone S, Garros A, et al. High-resolution impedance manometry after sleeve gastrectomy: increased intragastric pressure and reflux are frequent events. Obes Surg. 2016;26(10):2449–56.

    Article  Google Scholar 

  9. 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(12):2360–7.

    Article  Google Scholar 

  10. Elariny H, González H, Wang B. Tissue thickness of human stomach measured on excised gastric specimens from obese patients. Surg Technol Int. 2005;14:119–24.

    PubMed  Google Scholar 

  11. 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(1):8–19.

    Article  Google Scholar 

  12. 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 metaanalysis of 9991 cases. Ann Surg. 2013;257(2):231–7.

    Article  Google Scholar 

  13. Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26:1509–15.

    Article  Google Scholar 

  14. Gagner M, Hutchinson C, Rosenthal R. Fifth International Consensus Conference: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2016;12(4):750–6. https://doi.org/10.1016/j.soard.2016.01.022.

    Article  Google Scholar 

  15. Saber AA, Azar N, Dekal M, et al. Computed tomographic scan mapping of gastric wall perfusion and clinical implications. Am J Surg. 2015;209(6):999–1006.

    Article  Google Scholar 

  16. Benedix F, Benedix DD, Knoll C, Weiner R, Bruns C, Manger T, Stroh C, Obesity Surgery Working Group. 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(10):1610–6.

    Article  Google Scholar 

  17. Rached AA, Basile M, El Masri H. Gastric leaks post sleeve gastrectomy: review of its prevention and management. World J Gastroenterol. 2014;20(38):13904–10.

    Article  Google Scholar 

  18. Csendes A, Braghetto I, León P, Burgos AM. Management of leaks after laparoscopic sleeve gastrectomy in patients with obesity. J Gastrointest Surg. 2010;14:1343–8.

    Article  Google Scholar 

  19. Dakwar A, Assalia A, Khamaysi I, Kluger Y, Mahajna A. Late complication of laparoscopic sleeve gastrectomy. Case Rep Gastrointest Med. 2013;2013:136153.

    PubMed  PubMed Central  Google Scholar 

  20. Triantafyllidis G, Lazoura O, Sioka E, Tzovaras G, Antoniou A, Vassiou K, Zacharoulis D. Anatomy and complications following laparoscopic sleeve gastrectomy: radiological evaluation and imaging pitfalls. Obes Surg. 2010;21(4):473–8. https://doi.org/10.1007/s11695-010-0236-6.

    Article  Google Scholar 

  21. Gärtner D, Ernst A, Fedtke K, Jenkner J, Schöttler A, Reimer P, Blüher M, Schön MR. Routine fluoroscopic investigations after primary bariatric surgery. Chirurg. 2016;87:241–6. https://doi.org/10.1007/s00104-015-0063-3.

    Article  PubMed  Google Scholar 

  22. 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. https://doi.org/10.1007/s00423-016-1464-6.

    Article  Google Scholar 

  23. Doumouras AG, Maeda A, Jackson TD. The role of routine abdominal drainage after bariatric surgery: a metabolic and bariatric surgery accreditation and quality improvement program study. Surg Obes Relat Dis. 2017;13(12):1997–2003.

    Article  Google Scholar 

  24. 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.

    Article  Google Scholar 

  25. Musella M, Milone M, Bianco P, Maietta P, Galloro G. Acute leaks following laparoscopic sleeve gastrectomy: early surgical repair according to a management algorithm. J Laparoendosc Adv Surg Tech A. 2016;26(2):85–91. https://doi.org/10.1089/lap.2015.0343.

    Article  PubMed  Google Scholar 

  26. Serra C, Baltasar A, Andreo L, et al. Treatment of gastric leaks with coated self-expanding stents after sleeve gastrectomy. Obes Surg. 2007;17(7):866–72.

    Article  Google Scholar 

  27. Bege T, Emungania O, Vitton V, et al. An endoscopic strategy for management of anastomotic complications from bariatric surgery: a prospective study. Gastrointest Endosc. 2011;73(2):238–44.

    Article  Google Scholar 

  28. Eloubeidi MA, Talreja JP, Lopes TL, Al-Awabdy BS, Shami VM, Kahaleh M. Success and complications associated with placement of fully covered removable self-expandable metal stents for benign esophageal diseases (with videos). Gastrointest Endosc. 2011;73(4):673–81.

    Article  Google Scholar 

  29. 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;206:935–9.

    Article  Google Scholar 

  30. Galloro G, Magno L, Musella M, Manta R, Zullo A, Forestieri P. A novel dedicated endoscopic stent for staple-line leaks after laparoscopic sleeve gastrectomy: a case series. Surg Obes Relat Dis. 2014;10:607–11.

    Article  Google Scholar 

  31. 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. https://doi.org/10.1016/j.soard.2016.12.019. Epub 2016 Dec 26.

    Article  PubMed  Google Scholar 

  32. Keren D, Eyal O, Sroka G, et al. Over-the-scope clip (OTSC) system for sleeve gastrectomy leaks. Obes Surg. 2015;25(8):1358–63.

    Article  CAS  Google Scholar 

  33. Mercky P, Gonzalez JM, Aimore Bonin E, et al. Usefulness of over-the-scope clipping system for closing digestive fistulas. Dig Endosc. 2015;27(1):18–24.

    Article  Google Scholar 

  34. Smallwood NR, Fleshman JW, Leeds SG, Burdick JS. The use of endoluminal vacuum (E-Vac) therapy in the management of upper gastrointestinal leaks and perforations. Surg Endosc. 2016;30(6):2473–80.

    Article  Google Scholar 

  35. 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.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Digestive Surgery, Clinica Las Condes, Santiago, Chile

    Camilo Boza, Ricardo Funke & Camilo Duque S.

Authors
  1. Camilo Boza
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  2. Ricardo Funke
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  3. Camilo Duque S.
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Corresponding author

Correspondence to Ricardo Funke .

Editor information

Editors and Affiliations

  1. Department of Surgery, Sacré-Coeur Hospital, Montréal, QC, Canada

    Michel Gagner

  2. Bariatric Surgery, Gastro Obeso Center, Sao Paulo, Brazil

    Almino Ramos Cardoso

  3. Diagnomed, University of Buenos Aires, Buenos Aires, Argentina

    Mariano Palermo

  4. Emirates Specialty Hospital, Dubai, United Arab Emirates

    Patrick Noel

  5. CHU Montpellier, Saint Gely du Fesc, France

    David Nocca

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Boza, C., Funke, R., Duque S., C. (2020). Leaks and Fistulas After Sleeve Gastrectomy. In: Gagner, M., Cardoso, A., Palermo, M., Noel, P., Nocca, D. (eds) The Perfect Sleeve Gastrectomy. Springer, Cham. https://doi.org/10.1007/978-3-030-28936-2_24

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  • DOI: https://doi.org/10.1007/978-3-030-28936-2_24

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-28935-5

  • Online ISBN: 978-3-030-28936-2

  • eBook Packages: MedicineMedicine (R0)

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