Percutaneous CT-Guided Drainage of Gastric Leaks Post-Sleeve Gastrectomy

Abstract

Objectives: The aim of this study was to assess the safety and efficacy of percutaneous CT-guided drainage of gastric leaks post sleeve gastrectomy. Methods: For this single-center retrospective study, we reviewed the clinical data of 78 patients (44 men and 34 women with an average age of 34.6 ± 10.5 years and a body mass index (BMI) of 45 kg/m 2 ± 3.2) that underwent percutaneous CT-guided drainage of gastric leaks due to sleeve gastrectomy from September 2011 to September 2018. The outcome measurements were technical and clinical success, complications, and the need for revisional surgery. Results: The technical success rate of drain insertion was 97.5% (76/78 patients). All of the patients (76/76 patients) exhibited early clinical and laboratory improvement, and no emergency surgery was required. However, six patients underwent revisional surgery after 3 -5 months for non-healing gastric leaks/fistulas. One patient had a major complication of active bleeding due to arterial injury; this was managed by transcatheter coil embolization. All patients underwent endoluminal stent placement and received antimicrobial therapy and nutritional support. Conclusion: Percutaneous CT-guided drainage of gastric leaks after sleeve gastrectomy is a safe, effective, and minimally invasive alternative to surgery. This technique is in line with other conservative measures (endoluminal stent placement, antimicrobial therapy, and nutritional support), which heal most gastric leaks due to sleeve gastrectomy and prevent the need for revisional surgery.

Plain X-ray findings of post sleeve gastrectomy gastric leak

“…This unique location causes variable symptoms in the patient, including chest and upper abdominal symptoms. [ 1 , 3 ] Majority of patients develop intermediate (3-14 days) to late (more than 14 days) postoperative gastric leak (98.75%). Early gastric leak constitutes only 1.25% of the reported postoperative gastric leak.…”

“…Similarly, early routine postoperative radiology examinations like early CT and upper gastrointestinal contrast fluoroscopy on the first and second postoperative days are almost always negative. [ 3 , 4 ]…”