Diagnosis and management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity.
BACKGROUND
Laparoscopic sleeve gastrectomy (LSG) is increasingly being recognised as a valid stand-alone procedure for the surgical management of morbid obesity. The leak rate from the gastric staple line ranges from 1.4% to 20%. From our experience of management of LSG leaks, we have been able to formulate an algorithm-based approach to the management of these patients.


METHODS
All patients referred to our hospital within a 24-month period with a diagnosis of gastric staple line leak in the background of a previous LSG were included in the study. A retrospective case note review was undertaken for these patients and an algorithm formulated.


RESULTS
There were fourteen patients in the study. There were four males and ten females. Patients were managed with a combination of laparotomy, laparoscopy, endoscopic covered stenting, percutaneous radiologically guided drainage,jejunal enteric feeding and total parenteral nutrition. In five patients, re-look laparoscopy or laparotomy with washout and drainage was performed. The remaining eight patients were managed conservatively. There were no deaths.


CONCLUSIONS
Although it is often disappointing when LSG leaks do occur, with adherence to the basic tenets of the surgical management of enterocutaneous fistulae as well as early detection and a high index of suspicion, these complications can be successfully managed using an algorithm-based multi-disciplinary team approach.
Tan
Jeremy T
JT
Department of General Surgery, Sir Charles Gairdner Hospital, Hospital Ave, Western Australia, Australia. jthtan1@gmail.com
Kariyawasam
Sanjeeva
S
Wijeratne
Thejana
T
Chandraratna
Harsha S
HS
D000328:Adult; D000465:Algorithms; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D005750:Gastric Juice; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy; D011859:Radiography; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000009:adverse effects