Postoperative Bleeding and Leakage After Sleeve Gastrectomy: a Single-Center Experience

Abstract

Postoperative bleeding was defined as a drop of hemoglobin of more than 2 g associated with pallor, tachycardia, and abdominal pain and distension. Intra-abdominal fluid collections were sought by abdominal CT scan.All patients who had bleeding (as defined before) required blood transfusion; however, major bleeding that required reoperation was seen in three patients who presented not only with drops of hemoglobin and tachycardia but they were in a state of shock, and they required urgent resuscitation and reoperation laparoscopically. All patients presented with postoperative bleeding and none was intraoperative [1].Our rate of postoperative bleeding was within the range of what has been reported in the literature, and we did not encounter intraoperative bleeding.We avoid using clips or electrocoagulation since we think they are unsafe and may contribute to increase risk of postoperative leak. Instead, we suture the staple line, which is cheap too and we inspect it carefully. If we notice any further bleeding, we reinforce the site of bleeding with figure of eight stitch rather than using clips or electrocoagulation. With this technique that we have adopted lately, we have noticed further reduction in our postoperative bleeding rate.We had no leaks in our series and regional ischemia, and leak following oversewing was shown in animal studies and was not supported by clinical studies.

Postoperative Bleeding Risk after Sleeve Gastrectomy. A Two Techniques of Stapled Line Reinforcement Comparative Study in 4996 Patients

“…In our study, in four cases of the Group A and, in three cases of the Group B, the source could not be revealed at the time of re-operation. In such cases is difficult to understand what it should be done in order to diminish the risk how long we do not know which is in fact the source (9).…”

“…As for the need of routinely placement of a drainage tube, this fact is also intensely debated; therefore, certain authors consider that placing these devices will not be able to provide a faster diagnostic of this complication due to the fact that the tube can be rapidly clogged with blood clots (22). Moreover, these drainage tubes are usually removed within the 24 hours while a significant number of cases develop this complication after this interval of time (9).…”

“…A more effective and safe method seems to be represented by over sewing on the whole length of the stapling line. The method is not expensive, reproducible and well standardized, providing in the meantime an efficient tool to diminishing the risk of both early and late gastric leaks (9). However, certain authors consider that over sewing is associated with longer operative times and therefore, with higher costs due to a longer stay in the operating room (26)(27)(28).…”

“…However, certain authors consider that over sewing is associated with longer operative times and therefore, with higher costs due to a longer stay in the operating room (26)(27)(28). More elaborated cost analysis came to demonstrate that although the time spent in the operating room and therefore the cost of surgery is higher if over sewing is performed, these costs are amortized by the use of a cheaper material (the price of a stitch being lower when compared to buttress material or other glues) as well as, by the lower rates of postoperative bleedings necessitating administration of blood products or even re-operation (9).…”

Unplanned reoperation after radical gastrectomy for gastric cancer: causes, risk factors, and long-term prognostic influence

“…Previous studies indicated that early postoperative bleeding is associated with surgeons’ technical failure, 12 , 22 such as lack of experience in the procedure of hemostasis and vessel ligatures, and anastomotic bleeding. Abdominal arterial bleeding usually occurs in splenic artery, hepatic artery, and gastroduodenal artery, with the incidence ranging from 0.6% to 3.3%, and the main reason for hemorrhage was anastomotic leakage.…”