Gastric Leak after Laparoscopic Sleeve Gastrectomy

Abstract

Background: Laparoscopic sleeve gastrectomy (LSG) has increased in popularity as a definitive bariatric operation. LSG had significant morbidity like stenosis, leak along the staple line, and bleeding. Gastric leak after LSG is serious and life threating complication. It requires high index of suspicion for early diagnosis and proper management. Patients and methods: From September 2012 till October 2015, 120 morbidly obese patients with a mean BMI of 49±9 underwent laparoscopic sleeve gastrectomy (LSG) at Ain Shams University hospitals. LSG was discussed in details with the patients with emphasis on the benefits and more importantly the potential complications and side effects of LSG and written consent was taken. Results: 120 patients underwent LSG at Ain Shams University hospitals from them 4 patients (3.3%) developed a gastric leak. Of these 4 patients, 3 (75%) were women and 1 (25%) man. The patients had a mean age of 42.5 years and a body mass index (BMI) of 48.4 kg/m2. Leaks were diagnosed at a median of 7 days. All cases of leakage were managed conservative by antibiotics, proton pump inhibitor (PPI), total parenteral nutrition and a self-expanding stent was placed under fluoroscopic and endoscopic control (coated metallic stents). Mean healing time was 45 days (range 21–60), mean hospital stay was 10 days. No patient required reoperation and there was no mortality. Conclusion: Gastric leak after LSG is low but serious and life threating complication. It required early diagnosis and proper management. Conservative treatments are effective but require long hospital stay.