Gastric Leak After Sleeve Gastrectomy: Analysis of Its Management

Abstract

Diagnosis of a leak after a SG required a greater index of suspicion in order to perform an early diagnosis. Sepsis control and nutritional support are the cornerstones of this treatment. Evolution is characterized by longer periods of time that are necessary in order to wait until the leak closes. Management must be tailored to each patient.

Endoscopic stenting for laparoscopic sleeve gastrectomy leaks

“…Covered self-expandable metallic stents have gained popularity in the management of leaks with variable results (5)(6)(7)(8)(9)(10)12). In our study, we obtained complete closure of the leaks by using variable length SECS.…”

“…Despite the technical simplicity of the procedure, staple-line leaks are life-threatening complications that occur in approximately 5% of LSG cases (8)(9)(10). Symptoms may be gradual or sudden.…”

“…Although the long stents we used had additional anchoring wires, they migrated as the short stents did. Stent migration has been reported frequently in the literature and is a complication that requires re-interventions (8,15). In our patients who encountered stent migration, we either had to change or reposition them.…”

Endoscopic management of postoperative fistulas and leaks

“…Stent placement is effective for leaks after sleeve gastrectomy as well. 62,63 Stent placement for leaks in the lower GI tract in a challenging endeavor. The increased motility of lower GI tract causes stent migration both distally and proximally.…”

Complications in bariatric surgery

“…[24] Immediate surgical intervention in an unstable patient with washout drainage and, if possible, suture show better outcome. [3] For clinically stable patient, more conservative approach with adequate hydration, proton pump inhibitors, nil per os, nutritional support, percutaneous drainage of any collection and broad spectrum antibiotics are more reasonable.…”