Management of gastrointestinal leaks after surgery for clinically severe obesity

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

“…It is estimated that 75 to 85% of leaks after SG will occur at the proximal third of the greater curvature staple line as opposed to the distal or antral staple line [12,58]. There are a few series that have reported leaks exclusively at the proximal third of the greater curvature staple line [59][60][61]. Leaks have been reported to occur in the early postoperative period within a few days of surgery; however, most series report leaks occurring after more than 5 days (5 to >8) after surgery in 50 to 80% of patients [62][63][64][65].…”

“…Routine early postoperative UGI contrast studies is seldom advocated in most centers [25,58,60,65,[81][82][83]. Early postoperative UGI contrast studies have very low sensitivity to detect a leak early after SG, as most leaks are reported to occur after hospital discharge and more than 10 days after surgery [12].…”

“…Inclusion of the chest may help rule out other causes of tachycardia such as pneumonia, pulmonary embolism or pleural effusion. CT results are also influenced by patient factors, the experience of the radiologist, the size of the leak, and the contrast material used; however, high sensitivity (83 to 93%) [58,60,65] and specificity (75 to 100%) [65,83] are reported in most series. As with GI leak after GB, laparoscopic or open re-exploration is an also appropriate diagnostic option, regardless of the feasibility of obtaining a post-operative imaging test, when a GI leak is suspected.…”

The role of endoscopy in the bariatric surgery patient

“…The use of carbon dioxide may be preferable to room air for insufflation. Fibrin glue injection, placement of clips, or insertion of fully covered selfexpandable metal stents (SEMSs) have been used successfully to seal postoperative leaks in some patients [68,69].…”

Comparative Study Between Laparoscopic Adjustable Gastric Banded Plication and Sleeve Gastrectomy in Moderate Obesity—2 Year Results

“…However, it also mentioned that LSG has a risk/benefit profile between laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass (LRYGB) [15]. Staple line leaks and bleeding after LSG continue to be the most serious complications and occur in 1-3 % of patients in large published series [16].…”