title: Acute Leaks Following Laparoscopic Sleeve Gastrectomy: Early Surgical Repair According to a Management Algorithm.
abstract: BACKGROUND
  Despite leakages remaining a worrisome complication, laparoscopic sleeve gastrectomy (LSG) has become the preferred choice for most bariatric surgeons in Italy. In light of the emerging trend to discharge patients on postoperative day (POD) 1 or to consider LSG as an outpatient procedure, we felt it useful in selected cases to define a treatment protocol aimed to manage patients presenting with an acute postoperative leakage.
  
  
  METHODS
  Starting from 2007, 295 LSGs have been performed at our institution. Six patients, including 5 from our series (1.6%), were treated for a leak. The first patient presented a leak on POD 3, whereas the next 2 patients were re-admitted on POD 11 and 12, respectively. They all underwent a conservative treatment. The last 3 patients, according to a suggested algorithm, underwent a prompt surgical repair.
  
  
  RESULTS
  The conservatively treated patients were discharged following 22 ± 7.7 days, whereas patients treated by surgery were discharged following 10 ± 0.8 days (P = .09). By not considering the cost of primary LSG, which is about 5600 € in our region, the expense for every patient treated by re-intervention was about 2500 €. The cost for each patient treated by stenting was about 4700 €. The cost for each patient treated conservatively was about 5700 €.
  
  
  CONCLUSIONS
  According to our series and in agreement with published data, it is reasonable in selected cases to consider a wider role for early surgery. A timely surgical approach following an appropriate algorithm may offer a resolutive and cost-effective answer to the management of acute leaks following LSG.
authors.affiliation: 1 General Surgery, Advanced Biomedical Sciences Department, "Federico II" University , Naples, Italy .
authors.forename: Mario
authors.initials: M
authors.lastname: Musella
authors.affiliation: 1 General Surgery, Advanced Biomedical Sciences Department, "Federico II" University , Naples, Italy .
authors.forename: Marco
authors.initials: M
authors.lastname: Milone
authors.affiliation: 1 General Surgery, Advanced Biomedical Sciences Department, "Federico II" University , Naples, Italy .
authors.forename: Paolo
authors.initials: P
authors.lastname: Bianco
authors.affiliation: 1 General Surgery, Advanced Biomedical Sciences Department, "Federico II" University , Naples, Italy .
authors.forename: Paola
authors.initials: P
authors.lastname: Maietta
authors.affiliation: 2 Surgical Endoscopy, Clinical Medicine and Surgery Department, "Federico II" University , Naples, Italy .
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Galloro
mesh_terms: D000208:Acute Disease; D000328:Adult; D000465:Algorithms; D057868:Anastomotic Leak / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D000066491:Clinical Decision-Making; D003661:Decision Support Techniques; D005260:Female; D005743:Gastrectomy / Q000191:economics / Q000379:methods; D006801:Humans; D007558:Italy; D010535:Laparoscopy / Q000191:economics; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000191:economics / Q000601:surgery*; D012189:Retrospective Studies