Staple line leak with peritonitis after laparoscopic sleeve gastrectomy - a solution in one to six steps.

Abstract

IntroductionLaparoscopic sleeve gastrectomy (LSG) is one of the most efficient bariatric interventions in morbidly obese patients. The most severe risk of this procedure seems to be the staple line leak, and the management of this complication can be very arduous.AimTo share our experience in managing the staple line leak after LSG and to help to find the best procedure that should be preferred.Material and methodsIn the 2010–2015 period we performed 223 LSG, with about 5 demonstrating severe complications – two patients with severe bleeding requiring revision surgery, and three patients with resection surface leak.ResultsWe always primarily treated the staple line leak with a laparoscopic revision. Once the fistula did not spontaneously close after this treatment. A series of other methods were then indicated for this patient and only the sixth one resulted in the desirable therapeutic success. At first, our team opted for laparoscopic revision with drainage. The next procedure involved applying Ovesco and Boston clips. As a third method we performed abscess drainage through a nasobiliary tube inserted via gastroscopy. Due to failure we performed the second laparoscopic revision with staple line resuture, the next intervention was an open revision with fistula excision and suture, and finally we opted for the application of a self-expanding metallic stent, which proved to be definitely curative.ConclusionsWithout any guidelines it is very difficult to determine the right procedure addressing the staple line leak after LSG. It depends mainly on the clinician’s experience and is lengthy and often untraditional.

Gastric wall thickness and stapling in laparoscopic sleeve gastrectomy - a literature review.

“…Constant development of new methods for preventing gastric leaks, and controversies about oversewing of the staple line prove that studies of gastric wall biology from the perspective of bariatric surgery should be thoroughly analyzed [ 21 ]. It is especially important given that there are no clear guidelines on how to manage the leaks after sleeve gastrectomy, and the treatment outcomes are not always good [ 22 ].…”

The Birmingham experience of high-pressure methylene blue dye test during primary and revisional bariatric surgery: A retrospective cohort study

“…Bariatric surgery provides effective, durable and cost efficient management of morbid obesity and confers an increase in life expectancy, however staple line or anastomotic leak is a dreaded complication which often requires multiple corrective procedures, weeks of recovery for patients, and increased healthcare costs [8] , [9] , [10] , [11] .…”

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“…Кровотечение из линии шва, наиболее частое не септическое осложнение, наблюдается в среднем в 2.38% случаев и колеблется по разным оценкам от 1% до 6 %. Стеноз просвета наблюдается в среднем в 2.6% случаев и колеблется от 0 до 10 % [1,4,8,10,12,21,26,34,37,42,44]. В литературе в настоящее время нет документированных случаев летальности, связанной с хирургическими осложнениями, у пациентов с циррозом печени после слив-резекции желудка.…”

“…Выбор тактики лечения должен учитывать время возникновения несостоятельности (ранняя, промежуточная, поздняя), ее локализацию (верхняя, средняя или нижняя трети), тяжесть состояния пациента и выраженность клинических проявлений (тип I и II) [37].…”

“…При стабильном состоянии пациента в случае ранней несостоятельности, когда ткани находятся на ранних стадиях воспаления (до 3 суток), показано оперативное лечение в объеме санации, дренирования брюшной полости и ушивания дефекта [7,32,37].…”