Integrated Approaches for the Management of Staple Line Leaks following Sleeve Gastrectomy

Abstract

Introduction. Aim of the study was trying to draw a final flow chart for the management of gastric leaks after laparoscopic sleeve gastrectomy, based on the review of our cases over 10 years' experience. Material and Methods. We retrospectively reviewed all patients who underwent LSG as a primary operation at the Bariatric Unit of Tor Vergata University Hospital in Rome from 2007 to 2015. Results. Patients included in the study were 418. There were 6 staple line leaks (1.44%). All patients with diagnosis of a leak were initially discharged home in good clinical conditions and then returned to A&E because of the complication. The mean interval between surgery and readmission for leak was 13,4 days (range 6–34 days, SD ± 11.85). We recorded one death (16.67%) due to sepsis. The remaining five cases were successfully treated with a mean healing time of the gastric leak of 55,5 days (range 26–83 days; SD ± 25.44). Conclusion. Choosing the proper treatment depends on clinical stability and on the presence or not of collected abscess. Our treatment protocol showed being associated with low complication rate and minor discomfort to the patients, reducing the need for more invasive procedures.

Bariatric Surgery Closure During COVID-19 Lockdown in Italy: The Perspective of Waiting List Candidates

“…Bariatric surgery is by far the most effective therapy for morbid obesity and metabolic syndrome (4)(5)(6). All over the world, from the beginning of March 2020, lockdown regimens prevented patients with obesity from receiving bariatric surgery (7).…”

Pyogenic liver abscess after laparoscopic sleeve gastrectomy

“…A drainage catheter placement whether by image-guided percutaneous route or surgically is necessary to convert the gastric leakage content to a controlled fistula. 7 , 8 In the present case, because of an isolated unilocular pyogenic liver abscess without a staple line leak, percutaneous drainage catheter placement with antibiotic therapy was sufficient.…”

“…In case of doubt, contrast enhanced abdominal computerized tomography is the most sensitive diagnostic method for screening staple line leak, hematoma and abscess formation. 8 …”

Management of a Series of Staple Line Leaks Post Sleeve Gastrectomy: Experience of a Bariatric Surgery Center

“…We believe, and in this we are supported by numerous works present in the literature, that the treatment of SLL must avail itself of the skills of other specialties such as radiology, endoscopy, engineering, etc. [32]. According to scientific literature and our experience we [32,33] have developed our own decision-making algorithm based on our data and the evidence in the literature.…”