ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management

Clinical Efficacy of Jejunojejunostomy Leak Test Using Methylene Blue During Laparoscopic Roux-en-Y Gastric Bypass on Post-Operative Leak Rate

“…In obese patients, GI leak may have delayed clinical presentation or may be more subtle in management of leaks. The main principle is early diagnosis and treatment, which is an important issue for decreasing the occurrence of morbidity and mortality (16). Leak is a multifactorial condition.…”

Management of Distal Gastric Leak After Laparoscopic Sleeve Gastrectomy by Double Pigtail Catheter

“…Early GL occurs 1 to 4 days postsurgery, intermediate GL 5 to 9 days, and late GL 10 or more days [4]. There is no standard treatment protocol for manage- ment of GL, and the role of surgical treatment for GL after LSG is limited to two aims: adequate drainage in order to prevent abdominal sepsis in case of acute post-operative leak and as a definitive surgery for chronic fistulas that have been unsuccessfully treated using a conservative approach [5]. On the other hand, nonsurgical treatment of GL using SEMS, clips, and endoscopic-and percutaneous-placed drains or tissue sealantsis believed appropriate for stable patients [5].…”

“…There is no standard treatment protocol for manage- ment of GL, and the role of surgical treatment for GL after LSG is limited to two aims: adequate drainage in order to prevent abdominal sepsis in case of acute post-operative leak and as a definitive surgery for chronic fistulas that have been unsuccessfully treated using a conservative approach [5]. On the other hand, nonsurgical treatment of GL using SEMS, clips, and endoscopic-and percutaneous-placed drains or tissue sealantsis believed appropriate for stable patients [5]. Use of SEMS to treat postsurgical GL has become generally recommended due to research findings indicating that it is associated with a high rate of success.Nevertheless, migration and poor tolerance of the prosthesis arerelatively common and multiple endoscopies for replacements or adjustments are often required when using this approach [5,6].…”

“…On the other hand, nonsurgical treatment of GL using SEMS, clips, and endoscopic-and percutaneous-placed drains or tissue sealantsis believed appropriate for stable patients [5]. Use of SEMS to treat postsurgical GL has become generally recommended due to research findings indicating that it is associated with a high rate of success.Nevertheless, migration and poor tolerance of the prosthesis arerelatively common and multiple endoscopies for replacements or adjustments are often required when using this approach [5,6]. To overcome these challenges, extra-long, covered,self-expandable endoluminal stents have been developed whose use may decrease theincidence of stent-specific complications [7].Use of over-thescope clip (OTSC) is another approach that appears promising in bariatric surgery.…”

The use of over-the-scope clip in the treatment of persistent staple line leak after re-sleeve gastrectomy: Review of the literature

“…[24] However, the available data do not favour one treatment over another. [5] The endoscopic over-the-scope clip (OTSC) is a recently developed endoscopic method resulting in the full-thickness closure of the leakage site due to the enhanced ability of entrapping the tissue.…”