title: Gastric leakage after sleeve gastrectomy-clinical presentation and therapeutic options.
abstract: OBJECTIVE
  To analyze gastric leakage following sleeve gastrectomy depending on its point of detection and localization in order to evaluate therapeutic strategies.
  
  
  METHODS
  From Dec 2006 until June 2010, data of all patients undergoing bariatric surgery were entered into a prospectively documented database. Evaluation contained patient's gender, age, body mass index (BMI), type of surgery, clinical symptoms, diagnostics, onset and localization of leakage, type of therapy, length of stay (LOS), and clinical outcome.
  
  
  RESULTS
  Forty-five of 196 bariatric patients underwent sleeve gastrectomy, 22 male and 23 female with mean age 43 ± 9.7 years and mean BMI 54.9 ± 10 kg/m(2). Four patients developed a gastric leak (8.9%)-three proximal leaks and one distal leak. Leakage was detected by upper gastrointestinal (UGI) radiography in two cases, by gastroscopy in one case, and by abdominal computed tomographic (CT) scan in another case. In two cases, CT scan was not feasible because of patient's conditions. Three patients underwent relaparoscopy with re-suture of staple line, abdominal lavage, and placement of an intraabdominal drain. Both patients with proximal leaks required stent graft application as leakage reoccurred within 5 days after relaparoscopy. LOS varied between 30 and 120 days. None of the patients died.
  
  
  CONCLUSIONS
  The location of leakage, and the presence or absence of an intraabdominal drain are determining factors for its treatment. UGI radiography with contrast media and gastroscopy are comparable and superior to standard CT scan. Stent graft application is a promising therapy in case of proximal leakage; re-suture or resection of the staple line are possible solutions in case of a distal leak.
authors.affiliation: Klinik und Poliklinik für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie, Oberdürrbacher Str. 6 Haus A1/A2, 97080 Würzburg, Germany. jurowich_c@chirurgie.uni-wuerzburg.de
authors.forename: Christian
authors.initials: C
authors.lastname: Jurowich
authors.forename: Andreas
authors.initials: A
authors.lastname: Thalheimer
authors.forename: Florian
authors.initials: F
authors.lastname: Seyfried
authors.forename: Martin
authors.initials: M
authors.lastname: Fein
authors.forename: Gwendolyn
authors.initials: G
authors.lastname: Bender
authors.forename: Christoph-Thomas
authors.initials: CT
authors.lastname: Germer
authors.forename: Christian
authors.initials: C
authors.lastname: Wichelmann
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D057868:Anastomotic Leak / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000379:methods; D015992:Body Mass Index; D015331:Cohort Studies; D016208:Databases, Factual; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D005773:Gastroscopy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D015994:Incidence; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome