Comparison between major and minor surgical procedures for the treatment of chronic staple line disruption after laparoscopic sleeve gastrectomy.
BACKGROUND
Laparoscopic sleeve gastrectomy (LSG) has become the most common weight loss surgery procedure. The procedure's most dreaded surgical complication is staple-line disruption (SLD). So far, no definitive treatment modality has been established for this complication.


OBJECTIVE
The aim of this study is to review the treatment options used at our institution for patients with SLD after LSG and to evaluate the outcome of different interventions.


METHODS
A retrospective review of a prospectively collected database of all patients who underwent SLD between January 2005 and April 2014 was performed. SLD was defined as a leak identified on computed tomography or upper gastrointestinal series. We compared the cure rate between a major surgical procedure and patients treated with a variety of other minor treatment modalities. Special focus is given to the technique of proximal gastrectomy with Roux-en-Y esophagojejunostomy (PGEJ). The procedure consists of the en bloc resection of the proximal stomach immediately proximal to the gastroesophageal junction and including the fistulous tract. The jejunum is transected 50 cm distal to the ligament of Treitz and reconstruction of the gastrointestinal tract is performed with a Roux-en-Y esophagojejunostomy.


RESULTS
Thirty-one patients had SLD after their LSG. Patients were divided into 2 groups based on the treatment modality: Group A (PGEJ) and Group B (minor surgical procedure). Group A (n = 19) had 1 releak. Group B (n = 11) had 5 releaks. The cure rate for patients who underwent PGEJ was 94.7%. The cure rate for patients who were treated with a different approach was 54.5% (P = .01).


CONCLUSIONS
Our experience demonstrates that the cure rate of PGEJ is high. Minor surgical procedures are effective in approximately half of the patients, so when the leak becomes chronic, PGEJ can provide a long-term solution.
Department of General Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida.
Morris
M
Sasson
Department of General Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida.
Hira
H
Ahmad
Department of General Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida.
Fernando
F
Dip
Department of General Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida.
Emanuele Lo
EL
Menzo
Department of General Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida.
Samuel
S
Szomstein
Department of General Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida. Electronic address: rosentr@ccf.org.
Raul J
RJ
Rosenthal
D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D057868:Anastomotic Leak / Q000209:etiology / Q000601:surgery; D002908:Chronic Disease; D004946:Esophagostomy / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D007582:Jejunostomy / Q000379:methods; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D011446:Prospective Studies; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000009:adverse effects*; D013529:Surgical Wound Dehiscence / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
Bariatric surgery; Complication; Leak; Sleeve gastrectomy; Staple line disruption