J Metab Bariatr Surg.  2019 Dec;8(2):28-33. 10.17476/jmbs.2019.8.2.28.

The Causes, Prevention, and Management of Gastric Leakage after Laparoscopic Sleeve Gastrectomy: A Review Article

Affiliations
  • 1Division of Stomach Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. medigang@hanmail.net
  • 2Department of General Surgery, Northern Area Armed Forces Hospital, Hafar Al Batin, Saudi Arabia.
  • 3Department of General Surgery, King Fahad Military Medical Complex, Dhahran, Saudi Arabia.
  • 4Department of General Surgery, King Saud Medical City, Riyadh, Saudi Arabia.

Abstract

Obesity has been considered a chronic relapsing disease. The increasing number of obese individuals has resulted in an increase in the demand for bariatric surgeries annually. Post-laparoscopic sleeve gastrectomy complications are challenging for both patients and surgeons. Thus, this paper reviews the most common and significant risk factors for leakage occurrence after laparoscopic sleeve gastrectomy and presents new tools, techniques, management options, and recommendations, gathered from newly published articles, for post-laparoscopic sleeve gastrectomy leakage. Causes of post-laparoscopic sleeve gastrectomy leakage include technical factors such as bougie size, transection point, reinforcement materials, and patient co-morbidities as well as ischemic reasons. Ischemic leakage, which is most commonly seen in laparoscopic sleeve gastrectomy, occurs usually after the fourth day, although some leakage may appear earlier within 1-3 days due to technical issues. Use of varied bougie sizes results in similar excess weight loss % at the one-year follow-up. Buttressing materials also reduce post-laparoscopic sleeve gastrectomy bleeding, but not the leakage rate. Endoscopic stents play a significant role in gastric leakage treatment in post-laparoscopic sleeve gastrectomy patients. Intra-operative or even early postoperative diagnostic tools can help in detecting early leaks, but minor leaks as well as those due to ischemic causes may be missed. In conclusion, laparoscopic sleeve gastrectomy is still one of the most effective bariatric surgeries, exhibiting approximately 70% excess weight loss. Although complications of post-laparoscopic sleeve gastrectomy are severe and may be life-threatening, most patients can be treated conservatively. However, those with persistent fistula require surgical intervention.

Keyword

Bariatric surgery; Gastric fistula; Surgical staplers; Endoscopy; Digestive system; Stents

MeSH Terms

Bariatric Surgery
Digestive System
Endoscopy
Fistula
Follow-Up Studies
Gastrectomy*
Gastric Fistula
Hemorrhage
Humans
Obesity
Risk Factors
Stents
Surgeons
Surgical Staplers
Weight Loss
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