Laparo-Endoscopic Gastrostomy (LEG) Decompression: a Novel One-Time Method of Management of Gastric Leaks Following Sleeve Gastrectomy

Abstract

Leakage is the most feared and challenging complication following laparoscopic sleeve gastrectomy (LSG) as it can either be life-threatening or lead to major morbidity. Its management can be very complex. Endoscopic stents seem to be the mainstay of the current modality of treatment but are associated with a high rate of complications and also need supportive procedures for sepsis control and feeding. We aimed to approach this problem through a one-step intervention, achieving three objectives: a prolonged decompression of the gastric tube through a laparo-endoscopically placed gastrostomy, feeding jejunostomy and external drainage. Between 2014 January and March 2015, seven patients were managed for gastric leaks (post LSG) in our center by this novel approach. Their records were reviewed for details like prior operation, presence of comorbidities, if revisional surgery, day of presentation following surgery, intraoperative findings, post-op recovery, length of hospital stay, and time to heal. The results were tabulated and studied. Three were post primary LSG. Four were following revisional surgeries. Six out of seven (85.7 %) healed without alternative intervention. One patient with a large rent was managed by fistulojejunostomy. The average length of stay was 20.7 days. All patients were on postoperative enteral feeding through jejunostomy. There were no gastrostomy-related complications or mortality. Laparo-endoscopic gastrostomy (LEG) decompression is a feasible, single-step, successful procedure in managing post LSG leaks and may be a viable alternative to avoid stent-related morbidity.