Gastric leak after laparoscopic-sleeve gastrectomy for obesity.
BACKGROUND
One of the most serious complications after laparoscopic sleeve gastrectomy (LSG) is gastric leak. Few publications exist concerning the treatment of gastric leak. We sought to determine by way of a prospective study the clinical presentation, postoperative course, and treatment of gastric leak after LSG for obesity.


METHODS
From October 2005 to August 2008, 214 patients with different degrees of obesity underwent LSG. During surgery, each patient received saline with methylene blue by way of nasogastric tube and had a drain placed. All patients underwent radiologic study with liquid barium sulphate on postoperative day 3.


RESULTS
Seven patients developed gastric leak. Leak in two patients (28.6%) was diagnosed by upper gastrointestinal tract (UGI) study. Two patients had type I leak (28.6%), and five patients had type II leak (71.4%). Four patients underwent reoperation. Three patients were managed medically with enteral or parenteral feeding; the drain was maintained in situ; and collections were drained by percutaneous punctions guided by computed axial tomography. Mean hospital length of stay was 28.8 days, and time to leakage closure was 43 days after surgery.


CONCLUSIONS
Different ways exist to manage gastric leak, depending on the magnitude of the collection and the clinical repercussions. When treatment necessitates reintervention and is performed early, suture repair is more likely to be successful. Leakage closure time will vary.
Burgos
Ana Maria
AM
Department of Surgery, University Hospital University of Chile, Santos Dumont No. 999, Santiago, Chile. anamburgos@yahoo.com.mx
Braghetto
Italo
I
Csendes
Attila
A
Maluenda
Fernando
F
Korn
Owen
O
Yarmuch
Julio
J
Gutierrez
Luis
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011446:Prospective Studies; D011859:Radiography; D012086:Reoperation; D013529:Surgical Wound Dehiscence / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D055815:Young Adult