Outcome of Leaks After Sleeve Gastrectomy Based on a New Algorithm Adressing Leak Size and Gastric Stenosis

Abstract

Limited data can be found in the literature on leaks after LSG. A new algorithm based on leak size permits standardization of endoscopic management and reduces procedures after LSG.

Cost analysis of leak after sleeve gastrectomy

“…For seven patients, a double pigtail drain was inserted by endoscopy. In the other eight patients, stent deployment was necessary due to mid gastric stenosis or leak diameter greater than 10 mm based on an algorithm described in the previous report [8]. Further endoscopic treatment was performed between 6 and 8 weeks after for double pigtail drain or 4 weeks after the stent deployment.…”

“…The second reason lies in the lack of standardization in the management of leak, in particular with the endoscopic approach. Numerous studies have been written about the different approaches to the management of leaks after LSG, but only few of them have proposed an algorithm of endoscopic treatment of gastric [8,9]. Salvage surgery can also be used, when all endoscopic approaches have failed to close the leak, but it is associated with high risk of postoperative complications [10].…”

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

“…In a study of enternal drainage by DPC, Donatelli et al reported that 78.2% (50/64) of patients were cured and 52% (26/50) of the cured patients did not need additional endoscopic sessions [1].In their study, all patients were kept nil by mouth and provided with enteral nutrition, with the exception of 11 patients who were provided with a normal diet due to complete blockage of a small leak after placement of the stent.Based on the long-term results of their study of DPC, Donatelli et al concluded that enternal drainage by DPC is a valid, curative, and safe method that should be considered the primary approach toward management ofGL in the absence of diffuse peritonitis or multiorgan failure. In support of this conclusion,an algorithm developed by Nedelcu et al to assist in the choice of treatment based on GL size and presence of gastric stenos (GS) identified use of DPC as the treatment of choice in patients with gastric leaks<1 cm in the absence of GS [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.…”

Sleeve Gastrectomy Leaks: The Way we Treat it

“…9,[14][15][16][17] With the increasing experience of surgeons performing LVSG and treating complications, Nedelcu has recently proposed an algorithm for treatment based on size of the leak and stenosis of the sleeve. 18 The aim of this study was to review our experience and outcomes of LVSG treatment and design an algorithm of successful treatment.…”