title: Outcome of leaks after sleeve gastrectomy based on a new algorithm adressing leak size and gastric stenosis.
abstract: BACKGROUND
  Leaks after laparoscopic sleeve gastrectomy (LSG) are estimated to be the most serious complication of this procedure due to difficult healing process using non-standardized endoscopic approaches. Initially, endoscopic management recommended the use of stents.
  
  
  METHODS
  A total of 19 patients received endoscopic treatment after LSG to manage leaks. The leak was classified depending on the primary orifice's size (more or less than 10 mm) or on the presence of gastric stenosis. The primary aim was to develop a therapeutic algorithm in order to reduce the number of endoscopic procedures.
  
  
  RESULTS
  The average number of endoscopic procedures was 2.8 (range 2-5) in group A (leak size <10 mm) and 4 (range 3-7) in group B (leak size >10 mm). Two out of 13 patients had stent migration (15.4 %) and required an additional procedure, one in group A and another in group B. The average duration to achieve complete healing was 3.4 months (range 2-14 months), 2.8 months for group A and 3.9 months for group B.
  
  
  CONCLUSIONS
  Limited data can be found in the literature on leaks after LSG. A new algorithm based on leak size permits standardization of endoscopic management and reduces procedures after LSG.
authors.affiliation: Digestive and Endocrine Surgery, University Hospital of Strasbourg, 1, Place de l'Hôpital, 67091, Strasbourg, France, nedelcu.marius@gmail.com.
authors.forename: Marius
authors.initials: M
authors.lastname: Nedelcu
authors.forename: Thierry
authors.initials: T
authors.lastname: Manos
authors.forename: Adrian
authors.initials: A
authors.lastname: Cotirlet
authors.forename: Patrick
authors.initials: P
authors.lastname: Noel
authors.forename: Michel
authors.initials: M
authors.lastname: Gagner
mesh_terms: D000328:Adult; D000465:Algorithms; D057868:Anastomotic Leak / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000379:methods; D003251:Constriction, Pathologic / Q000209:etiology; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D015607:Stents; D013270:Stomach / Q000473:pathology*; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult