Definitive surgical management of staple line leak after sleeve gastrectomy

Management of gastric leaks after sleeve gastrectomy with endoluminal vacuum (E-Vac) therapy

“…Gastric leaks after laparoscopic sleeve gastrectomy (LSG) have proven to be a disastrous complication resulting in longer hospital stays and the need to use a number of modalities for rescue [1][2][3][4][5][6]. The LSG procedure has flourished [7,8], bringing about the decline of leak rates from the procedure while making the resolution of such leaks a larger concern for all surgeons dealing with LSG patients during the postoperative period.…”

“…Options for management-including reoperation [1,3,4,9,10], endoscopic management with clips or stents [5,6,11], Over-Stitch [12], and other modalities [13,14]-have had good outcomes. There has been no evidence in the literature of use of endoluminal vacuum (E-Vac) therapy for LSG leaks; however, E-Vac therapy has been used with good results for a variety of foregut leaks and perforations, and in some cases, better results than with the use of stents [15][16][17][18][19].…”

Open total gastrectomy with Roux-en-Y reconstruction for a chronic fistula after sleeve gastrectomy

“…Malnutrition occurs in many complicated obese patients [13,20,26], and our experience shows that nutritional status was unrelated to weight or changes in BMI. In the present study, enteral nutrition was used for all patients to achieve a preoperative albumin level of 30 g/L; definitive surgical treatment should be delayed until the patient has been nutritionally optimized [20].…”

“…At this time, endoscopic treatment has been found to be ineffective and surgery is then mandatory [8,11]. There are 3 surgical options: conversion into a LRYGB [12,13], a Roux-limb placement [12][13][14][15][16][17], or resection surgery (total gastrectomy with an esojejunostomy) [3,12]. The first 2 options have proven their feasibility and efficacy (short series), but an open total gastrectomy is sometimes required in challenging situations (inflammation, fibrosis, dissection, adhesions) [12][13][14][15][16][17][18].…”

Endolumenal Vacuum Therapy and Fistulojejunostomy in the Management of Sleeve Gastrectomy Staple Line Leaks

“…There are five published reports describing FJ usage in 48 patients ( Table 1 ) [ 2 , 5 – 9 ]. The largest series by Chouillard et al showed 27 patients with complete resolution of the chronic fistula; 3 patients were lost to follow-up.…”