Risk Factors for Gastrointestinal Leak after Bariatric Surgery: MBASQIP Analysis

Alizadeh, Reza; Li, Shiri; Inaba, Colette S.; Penalosa, Patrick; Hinojosa, Marcelo W.; Smith, Brian R.; Stamos, Michael J.; Nguyen, Ninh T.

doi:10.1016/j.jamcollsurg.2018.03.030

Cited by 87 publications

(53 citation statements)

References 37 publications

(33 reference statements)

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“…Laparoscopic sleeve gastrostomy is a popular operation, and in the US, LSG has surpassed Roux-en-Y gastric bypass because of more favorable outcomes of lower mortality and overall morbidity, similar weight loss, and resolution of health comorbidities at 5 years [163][164][165][166]. Further supporting LSG as a preferred procedure is the lower leak rates, the twofold lower complication rate, and a mortality rate that is half that of Roux-en-Y gastric bypass [167]. Our current meta-analysis of 148 articles gathering data on 40,653 LSG patients, demonstrates an overall leak rate of 1.5% among the 5 staple-line reinforcement methods evaluated.…”

Section: Discussionmentioning

confidence: 99%

Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review

2019

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Background Staple-line leaks following laparoscopic sleeve gastrectomy (LSG) remain a concerning complication. Stapleline buttressing is largely adopted as an acceptable reinforcement but data regarding leaks have been equivocal. This study compared staple-line leaks in five reinforcement options during LSG: no reinforcement (NO-SLR), oversewing (suture), nonabsorbable bovine pericardial strips (BPS), tissue sealant or fibrin glue (Seal), or absorbable polymer membrane (APM). Methods This systematic review study of articles published between 2012 and 2016 regarding LSG leak rates aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Variables of interest included leak rates, bleeding, and complications in addition to surgical and population parameters. An independent Fisher's exact test was used to compare the number of patients with and without leaks for the different reinforcement options. Results Of the 1633 articles identified, 148 met inclusion criteria and represented 40,653 patients. Differences in age (older in APM; p = 0.001), starting body mass index (lower in Suture; p = 0.008), and distance from pylorus (closer in BPS; p = 0.04) were observed between groups, but mean bougie size was equivalent. The overall leak rate of 1.5% (607 leaks) ranged from 0.7% for APM (significantly lower than all groups; p ≤ 0.007 for next lowest leak rate) to 2.7% (BPS). Conclusions This systematic review of staple-line leaks following LSG demonstrated a significantly lower rate using APM staple-line reinforcement as compared to oversewing, use of sealants, BPS reinforcement, or no reinforcement. Variation in surgical technique may also contribute to leak rates.

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Section: Discussionmentioning

confidence: 99%

Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review

2019

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“…Researchers have recently found that, in patients with low BMI, postoperative increased heart rate (tachycardia > 120 bpm), evidence of respiratory distress, and decreased hemoglobin were significantly associated with bleeding [11,12] . Alizadeh et al [13] reported that oxygen dependency, hypoalbumenia, sleep apnea, hypertension, and diabetes were critical factors related to increased risk of leak [13] . In addition, preoperative platelet count, INR, and systolic blood pressure were not significantly related to postoperative bleeding [12] .…”

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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“…The gastrointestinal leak is a severe complication of bariatric surgery. Authors reported a decreasing worldwide incidence of post LSG leak to 0.5% [8]. In our practice, post LSG leak occurred in 0.4% of cases.…”

Section: Discussionmentioning

confidence: 50%

“…However, these algorithms were based on a limited number of patients, and no clear guidance is currently available. Some authors also tried to identify if any factors could cause a leak or affect the management [5,8]; however, no known factors have been studied to predict the outcomes of a leak or the time to resolution. This study presents the outcomes of the management algorithm for LSG leaks in patients who were managed in our center (2012-2017).…”

Section: Introductionmentioning

confidence: 99%

Management of leak after sleeve gastrectomy: outcomes of 73 cases, treatment algorithm and predictors of resolution.

2019

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Introduction Gastric leak post laparoscopic sleeve gastrectomy (LSG) is a severe complication that has been reported in 1.5-3% of cases. Management algorithms of leak exist; however, no known factors predict the time to resolution. This study aims to share outcomes of our management algorithm of post LSG leak, including the rate of resolution, complications, admission to the intensive care unit, conversion to other techniques, and mortality. To determine if any factors can predict the resolution time. Methods A retrospective analysis of patients who had LSG leaks and was managed in the main tertiary center in Qatar (January 2012-December 2017). Results A total of seventy-three patients had post LSG leaks. Fifty-six (76.7%) underwent LSG outside our center. Thirteen leaks (17.8%) were after revisional LSG. Laparoscopic exploration was performed in twenty patients (27.4%) and feeding jejunostomy in nine patients (12.3%). Patients were followed up for 12 months. All healed within 8.8 ± 0.72 weeks. The resolution rate was (97.1%) without surgical conversion, while two patients required fistulo-jejunostomy. No patient died. Complications occurred; re-leak (14.9%) and splenic abscess (2.9%). Patients on jejunal feeding had shorter resolution time (HR = 2.7, P = 0.018), while patients on total parenteral nutrition and post-endoscopic dilatation had 66% and 50% increases in the resolution time; (HR = 0.34, P = 0.026) and (HR = 0.5, P = 0.047), respectively. Conclusion Management of post-LSG leak is multimodal. Our clinical experience demonstrated less urge to perform extensive surgical interventions. Patients on enteral feeding had shorter resolution time while patients with sleeve stricture had a longer time to resolution.

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Risk Factors for Gastrointestinal Leak after Bariatric Surgery: MBASQIP Analysis

Abstract: The overall rate of gastrointestinal leak in bariatric surgery is low. Certain preoperative factors, procedural type (LRYGB), and interventions (intraoperative provocative test and surgical drain placement) were associated with a higher risk for leaks.

Cited by 87 publications

References 37 publications

Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review

Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review

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

Management of leak after sleeve gastrectomy: outcomes of 73 cases, treatment algorithm and predictors of resolution.

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