title: Management Algorithm for Leaks Following Laparoscopic Sleeve Gastrectomy.
abstract: BACKGROUND
  Leak after laparoscopic sleeve gastrectomy (LSG) is a serious complication. No clear algorithm has been described for management.
  
  
  METHODS
  We reviewed our prospective database for all leaks after LSG treated at the Bariatric and Metabolic Institute (BMI) Abu Dhabi from 2010 to 2014. Our management algorithm is based on the timing of the LSG leak, nutritional status of the patient, and the presence of stenosis or peritonitis. Acute leaks with or without peritonitis are treated by operatively or utilizing endoscopic stenting, respectively. LSG leaks with stenosis not amenable to endoscopic stenting are treated with laparoscopic Roux en Y esophagojejunostomy (LRYEJ).
  
  
  RESULTS
  We performed 236 LSG without a leak, and 14 LSG leaks were referred to our unit. Mean age was 35.6 years, and 50 % of patients were males. Mean BMI was 37 kg/m(2). The patients presented on average 13.9 weeks after LSG. Enteral feeding was used as the primary nutrition route in 85.5 % of patients. Our management strategy was operative in 78.4 % of patients (jejunostomy feeding in 57 % and LRYEJ in 21.4 % of patients) and conservative with or without stents in 21.6 % of patients. Mean in hospital length of stay (LOS) was 5.6 weeks. Our reoperation rate was 7 %. There were no mortalities and one patient 7 % developed pulmonary embolism. None of the patients treated returned with a leak or collection after a mean follow up of 23.6 months.
  
  
  CONCLUSIONS
  Treating leaks following LSG based on the timing of presentation, presence of stricture, and malnutrition is safe and effective.
authors.affiliation: Bariatric and Metabolic Institute (BMI), Abu Dhabi, United Arab Emirates. nimeri@gmail.com.|Surgery Institute, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates. nimeri@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Nimeri
authors.affiliation: Bariatric and Metabolic Institute (BMI), Abu Dhabi, United Arab Emirates.|Surgery Institute, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
authors.forename: M
authors.initials: M
authors.lastname: Ibrahim
authors.affiliation: Bariatric and Metabolic Institute (BMI), Abu Dhabi, United Arab Emirates.|Surgery Institute, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
authors.forename: A
authors.initials: A
authors.lastname: Maasher
authors.affiliation: Bariatric and Metabolic Institute (BMI), Abu Dhabi, United Arab Emirates.|Surgery Institute, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
authors.forename: M
authors.initials: M
authors.lastname: Al Hadad
mesh_terms: D000328:Adult; D000465:Algorithms; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D057868:Anastomotic Leak / Q000209:etiology* / Q000601:surgery; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000379:methods; D003251:Constriction, Pathologic / Q000209:etiology; D019468:Disease Management; D004750:Enteral Nutrition / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007582:Jejunostomy / Q000379:methods; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D010538:Peritonitis / Q000209:etiology; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D015607:Stents; D016896:Treatment Outcome
keywords: Algorithm for management; Leaks; Sleeve gastrectomy