title: Management of staple line leaks following sleeve gastrectomy.
abstract: BACKGROUND
  Leaks after laparoscopic sleeve gastrectomy (LSG) are not very frequent but are a difficult complication that can become chronic. Various treatment options have been suggested but no definitive treatment regimen has been established. The aim of our study is to report leak complications after LSG, their management, and outcomes.
  
  
  METHODS
  Between June 2008 and October 2013, a total of 539 patients underwent laparoscopic and robot-assisted laparoscopic sleeve gastrectomy at our institution. A retrospective review of a prospectively collected database was performed for all LSG patients, noting the outcomes and complications of the procedure.
  
  
  RESULTS
  Fifteen (2.8%) patients presented with a leak after LSG. The diagnosis was made at a mean of 27.2±29.9 days (range, 1-102) after LSG. Eight (53.3%) patients underwent conservative treatment initially and 6 (75.0%) of these patients required stenting as secondary treatment. Although leaks from 3 patients resolved with stenting, the other 3 required restenting and 2 eventually underwent conversion to gastric bypass. Five (33.3%) patients underwent endoscopic intervention, closing the leak with fibrin glue (n=3) or hemoclips (n=2). Two (13.3%) patients who were diagnosed with a leak immediately after LSG before discharge had their leak oversewn laparoscopically with an omental patch. Leaks in 9 (60.0%) patients did not heal after the first intervention, and the mean number of intervention required was 2.3±1.7 times (range, 1-7) for the treatment of this condition.
  
  
  CONCLUSIONS
  Management of leaks after LSG can be challenging. Early diagnosis and treatment is important in the management of a leak. However, it can be treated safely via various management options depending on the time of diagnosis and size of the leak.
authors.affiliation: Department of Bariatric Surgery, Orlando Regional Medical Center and Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida.
authors.forename: Rena C
authors.initials: RC
authors.lastname: Moon
authors.affiliation: Department of Bariatric Surgery, Orlando Regional Medical Center and Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida.
authors.forename: Nimesh
authors.initials: N
authors.lastname: Shah
authors.affiliation: Department of Bariatric Surgery, Orlando Regional Medical Center and Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida.
authors.forename: Andre F
authors.initials: AF
authors.lastname: Teixeira
authors.affiliation: Department of Bariatric Surgery, Orlando Regional Medical Center and Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida. Electronic address: muhammad.jawad@orlandohealth.com.
authors.forename: Muhammad A
authors.initials: MA
authors.lastname: Jawad
mesh_terms: D000328:Adult; D042241:Early Diagnosis; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D005743:Gastrectomy / Q000009:adverse effects*; D015391:Gastroplasty / Q000009:adverse effects; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects; D015607:Stents; D017792:Surgical Stapling / Q000009:adverse effects*; D013529:Surgical Wound Dehiscence / Q000175:diagnosis / Q000628:therapy*; D014014:Tissue Adhesives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives
keywords: Complications; Fibrin glue; Fistula; Hemoclip; Reoperation; Sleeve gastrectomy; Staple line leak; Stent