title: Perioperative hemorrhagic complications after laparoscopic sleeve gastrectomy: four-year experience of a bariatric center of excellence.
abstract: Bleeding and gastric fistula are the most common postoperative complications after laparoscopic sleeve gastrectomy (LSG). The long stapler line represents the most frequent source of bleeding, which ranges between 0 and 20%. The aim of this retrospective study was to analyze the 4-year experience of a high-volume center with respect to the prevention and management of perioperative LSG bleeding.
  
  
  
  The prospectively maintained database from June 2012 to June 2016 was reviewed. Outcomes, especially perioperative bleeding (until patient discharge), its management, and follow-ups, were analyzed.
  
  
  
  Out of 870 LSG (603 females, 267 males), 31 cases (3.5%) of postoperative complications were registered: bleeding was the most frequent complication (1.9%). Hemoperitoneum was managed laparoscopically in 9/17 patients (52.9%) with only one conversion to laparotomy (11.1%). Conservative treatment successfully controlled bleeding in 8/17 patients (47.1%). However, four patients (50%) developed an infected hematoma; two of them were treated conservatively with a CT-guided drainage, and the other two were complicated by late gastric leak treated laparoscopically. No mortalities occurred in the investigated cases.
  
  
  
  In a high-volume center, the expected incidence of bleeding after LSG is 1.7% even after the adoption of all preventive strategies. The intraoperative protocol for detecting silent bleeding was effective, and no cases of bleeding were observed since its application. Our findings showed that the conservative management of postoperative bleeding should be considered as a high-risk condition for late leakage.
authors.affiliation: Division of General Surgery and Bariatric Center of Excellence, Department of Medico-Surgical Sciences and Biotechnologies, La Sapienza University of Rome, Via F. Faggiana 1668, 04100, Latina, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: De Angelis
authors.affiliation: Division of General Surgery and Bariatric Center of Excellence, Department of Medico-Surgical Sciences and Biotechnologies, La Sapienza University of Rome, Via F. Faggiana 1668, 04100, Latina, Italy.|Faculty of Medicine, Gastroenterology Surgical Center (GEC), Mansoura University, Mansoura, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdelgawad
authors.affiliation: Division of General Surgery and Bariatric Center of Excellence, Department of Medico-Surgical Sciences and Biotechnologies, La Sapienza University of Rome, Via F. Faggiana 1668, 04100, Latina, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Rizzello
authors.affiliation: Unit of Anesthesia and ICU, Department of Medico-Surgical Sciences and Biotechnologies, La Sapienza University of Rome, Via F. Faggiana 1668, 04100, Latina, Italy.
authors.forename: Consalvo
authors.initials: C
authors.lastname: Mattia
authors.affiliation: Division of General Surgery and Bariatric Center of Excellence, Department of Medico-Surgical Sciences and Biotechnologies, La Sapienza University of Rome, Via F. Faggiana 1668, 04100, Latina, Italy. gianfranco.silecchia@uniroma1.it.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Silecchia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods; D006489:Hemostatic Techniques; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Bleeding; Hematoma; Hemostasis; Late leak complications management; Sleeve gastrectomy