title: Staple Line Leak After Primary Sleeve Gastrectomy-Risk Factors and Mid-term Results: Do Patients Still Benefit from the Weight Loss Procedure?
abstract: Staple line leak after laparoscopic sleeve gastrectomy (LSG) still represents the most feared complication. The purpose of this study was to investigate whether there are factors that increase the risk for a leakage. Furthermore, we aimed to analyze the impact of a leak on weight change and resolution of comorbidities.
  
  
  
  Since 2005, data from obese patients that undergo bariatric procedures in Germany are prospectively registered. For the current analysis, all adult subjects that had undergone primary LSG from 2005 to 2014 were considered.
  
  
  
  Overall, 241/15,756 (1.53%) patients experienced a leak. The occurrence of a leakage resulted in a significant increase of the mortality rate (3.7 vs. 0.2%; p < 0.01). Percent excess weight loss did not differ between leak and non-leak patients, both, at 12 (64.2 vs. 60.9%; p = 1.0) and 24 months (68.5 vs. 64.0%, p = 0.86). Similarly, no significant difference was observed for resolution rate of all comorbid conditions. Matched pair analysis confirmed these findings. Multivariable analysis identified operation time, conversion, intraoperative complications, and hypertension and degenerative joint disease as risk factors for a leak. Oversewing the staple line was associated with the lowest risk.
  
  
  
  The postoperative staple line leak after primary LSG significantly increases postoperative morbidity and mortality. We found that there are patient-related factors and operative variables that predispose to leakage after LSG. However, the occurrence of a leakage does not adversely impact the weight loss and resolution of comorbidities in the mid-term.
authors.affiliation: Department of Surgery, University Hospital Magdeburg, Leipziger Strasse 44, D-39120, Magdeburg, Germany. frankbenedix@gmx.de.
authors.forename: Frank
authors.initials: F
authors.lastname: Benedix
authors.affiliation: Department of Surgery, University Hospital Magdeburg, Leipziger Strasse 44, D-39120, Magdeburg, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Poranzke
authors.affiliation: StatConsult Magdeburg, Halberstädter Strasse 40a, D-39112, Magdeburg, Germany.
authors.forename: Daniele
authors.initials: D
authors.lastname: Adolf
authors.affiliation: Department of Surgery, University Hospital Magdeburg, Leipziger Strasse 44, D-39120, Magdeburg, Germany.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Wolff
authors.affiliation: Department of Surgery, University Hospital Magdeburg, Leipziger Strasse 44, D-39120, Magdeburg, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Lippert
authors.affiliation: Department of Surgery, University Hospital Magdeburg, Leipziger Strasse 44, D-39120, Magdeburg, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Arend
authors.affiliation: SRH Municipal Hospital Gera, Straße des Friedens 122, D-07548, Gera, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Manger
authors.affiliation: SRH Municipal Hospital Gera, Straße des Friedens 122, D-07548, Gera, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Stroh
mesh_terms: D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D005858:Germany / Q000453:epidemiology; D006801:Humans; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D017792:Surgical Stapling / Q000009:adverse effects / Q000706:statistics & numerical data
keywords: German multicenter trial; Leakage; Outcome; Risk factors; Sleeve gastrectomy