title: Management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity: A tertiary care experience and design of a management algorithm.
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed 'standalone' bariatric procedure in India. Staple line gastric leaks occur infrequently but cause significant and prolonged morbidity. The aim of this retrospective study was to analyse the management of patients with a gastric leak after LSG for morbid obesity at our institution.
  
  
  METHODS
  From February 2008 to 2014, 650 patients with different degrees of morbid obesity underwent LSG. Among these, all those diagnosed with a gastric leak were included in the study. Patients referred to our institution with gastric leak after LSG were also included. The time of presentation, site of leak, investigations performed, treatment given and time of closure of all leaks were analysed.
  
  
  RESULTS
  Among the 650 patients who underwent LSG, 3 (0.46%) developed a gastric leak. Two patients were referred after LSG was performed at another institution. The mean age was 45.60 ± 15.43 years. Mean body mass index (BMI) was 44.79 ± 5.35. Gastric leak was diagnosed 24 h to 7 months after surgery. One was early, two were intermediate and two were late leaks. Two were type I and three were type II gastric leaks. Endoscopic oesophageal stenting was used variably before or after re-surgery. Re-surgery was performed in all and included stapled fistula excision (re-sleeve), suture repair only or with conversion to roux-en-Y gastric bypass or fistula jujenostomy. There was no mortality.
  
  
  CONCLUSIONS
  Leakage closure time may be shorter with intervention than expectant management. Sequence and choice of endoscopic oesophageal stenting and/or surgical re-intervention should be individualized according to clinical presentation.
authors.affiliation: Department of Bariatric Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India.
authors.forename: Palanivelu
authors.initials: P
authors.lastname: Praveenraj
authors.affiliation: Department of Bariatric Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Gomes
authors.affiliation: Department of Bariatric Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India.
authors.forename: Saravana
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India.
authors.forename: Palanisamy
authors.initials: P
authors.lastname: Senthilnathan
authors.affiliation: Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India.
authors.forename: Ramakrishnan
authors.initials: R
authors.lastname: Parthasarathi
authors.affiliation: Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India.
authors.forename: Subbiah
authors.initials: S
authors.lastname: Rajapandian
authors.affiliation: Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India.
authors.forename: Chinnusamy
authors.initials: C
authors.lastname: Palanivelu