Management of Leaks After Sleeve Gastrectomy

Gomes, Rachel M.; Palaniappan, Rajkumar; Bhasker, Aparna Govil; Naik, Shivram; Shah, Sumeet

doi:10.1007/978-981-10-2705-5_23

Cited by 4 publications

(3 citation statements)

References 35 publications

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“…As mentioned, gastrointestinal staple-line leakage remains one of the most unavoidable complications after the procedure, resulting in increased healthcare cost and postoperative pain in patients [8] . According to several meta-analyses, gastrointestinal leak rate has been estimated to range from 2.5% to 7% after various types of bariatric surgery [6][7][8][9] . Postoperative gastrointestinal leak has been constantly dropping recently and its occurrence is low [10] ; nonetheless, leakage is still a principal complication, leading to increase morbidity and mortality rate.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of erythrocyte sedimentation rate levels as a predictor of staple-line leakage in bariatric surgery

Khezerloo¹,

Akbarzadeh²,

Eshghjoo³

et al. 2020

MIS

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Aim: Bariatric surgery is an effective treatment for morbid obesity that has inevitable complications including postoperative bleeding and staple-line leakage. Erythrocyte sedimentation rate (ESR) can be a clinical indicator for prediction of leakage. Methods: This retrospective cohort study was done on 1999 patients who underwent sleeve gastrectomy in Erfan Niyayesh Hospital, Tehran, Iran. ESR levels of patients were evaluated in cases which had postoperative leak. Statistical analyses were performed using SPSS software. Results: Among the 2350 patients, 50 subjects experienced gastric leak (2.12%). ESR mean was 73.1 mm/h for cases, statistically significantly higher in patients with leakage compared to the control group. In addition, ESR serum level mean was 31.34 mm/h for control groups. Other variables including C-reactive protein and platelet count were not statistically significant. Conclusion: Higher ESR serum level can be seen in various conditions, and, in obese patients who undergo bariatric surgery, it can be a reliable predictor for postoperative gastric leak complication.

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Section: Introductionmentioning

confidence: 99%

Diagnostic value of erythrocyte sedimentation rate levels as a predictor of staple-line leakage in bariatric surgery

Khezerloo¹,

Akbarzadeh²,

Eshghjoo³

et al. 2020

MIS

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“…Also a Roux limb allows for better drainage than a sleeve, which can have functional disorders or stenotic areas. Conversion of the LSG to a RYGB may not be advisable in the presence of signi icant peritonitis [11] studies have shown that early re-suturing within the irst three days can result in successful closure versus resuturing leaks after the third day. Hence this is considered as a 'favorable' window period and attempt at early surgical closure of the defect may be performed when re-exploration is early and tissues are healthy.…”

Section: Discussionmentioning

confidence: 99%

“…More de initive surgical options include: conversion of the LSG to a regular Roux-Y gastric bypass (RYGB) anastomosis of the jejunal Roux limb to the istula and total gastrectomy [11].…”

Section: Diagnosis Of a Gastric Leak Can Be Dif Icult As Thementioning

confidence: 99%

Leakage after sleeve gastrectomy: Endoscopic stenting VS surgical intervention

Abdel‐Hamid¹,

Gharib²,

Mohammed³

et al. 2020

Arch Surg Clin Res

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Background: Laparoscopic sleeve gastrectomy (LSG) is becoming more popular in the treatment of obesity. LSG is safe with a low morbidity. The complications rarely result in morbidity and even mortality. Leaks are the major complication associated with LSG with a reported prevalence between 1.9% and 2.4%. Objective: To compare surgical intervention and endoscopic stenting for treatment of gastric leakage after sleeve gastrectomy. Patients and method: Our study included 30 patients presented with post sleeve leaks discovered by routine postoperative imaging or during the follow up period. Patients were recruited from October 6th university hospital during the period from August 2017 to August 2019. Patients were divided to the following groups: 1) Endoscopy group: This included 15 patients with post sleeve leakage undergoing endoscopic stent insertion. 2) Surgery group: which included 15 patients with post sleeve leak age undergoing surgical management. This division was random. Results: Our study showed that Endoscopic stenting for management of post sleeve gastrectomy leakage is an eff ective method with lower morbidity and shorter post-operative hospital stay than surgical management. Some patients may be good candidates for early surgical intervention in type 1 leakage if managed early before dissemination of leakage and before tissues become friable. Complications of stents include stent migration (26%), stent related ulcer (13%) and stricture (13%). while the surgical intervention carries more complications (DVT, chest infection, wound infection and stricture) and longer postoperative hospital stay. Conclusion: endoscopic management of post-sleeve gastrectomy leakage with stenting is recommended because it successfully manages the leaks and avoids invasive procedures with less risk, with shorter hospital stay and early return of function.

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