Abstract
Objectives: The aim of this study was to assess the safety and efficacy of percutaneous CT-guided drainage of gastric leaks post sleeve gastrectomy. Methods: For this single-center retrospective study, we reviewed the clinical data of 78 patients (44 men and 34 women with an average age of 34.6 ± 10.5 years and a body mass index (BMI) of 45 kg/m2 ± 3.2) that underwent percutaneous CT-guided drainage of gastric leaks due to sleeve gastrectomy from September 2011 to September 2018. The outcome measurements were technical and clinical success, complications, and the need for revisional surgery. Results: The technical success rate of drain insertion was 97.5% (76/78 patients). All of the patients (76/76 patients) exhibited early clinical and laboratory improvement, and no emergency surgery was required. However, six patients underwent revisional surgery after 3 - 5 months for non-healing gastric leaks/fistulas. One patient had a major complication of active bleeding due to arterial injury; this was managed by transcatheter coil embolization. All patients underwent endoluminal stent placement and received antimicrobial therapy and nutritional support. Conclusion: Percutaneous CT-guided drainage of gastric leaks after sleeve gastrectomy is a safe, effective, and minimally invasive alternative to surgery. This technique is in line with other conservative measures (endoluminal stent placement, antimicrobial therapy, and nutritional support), which heal most gastric leaks due to sleeve gastrectomy and prevent the need for revisional surgery.
Highlights
The aim of this study was to assess the safety and efficacy of percutaneous computed tomography (CT)-guided drainage of gastric leaks post sleeve gastrectomy. For this single-center retrospective study, we reviewed the clinical data of 78 patients (44 men and 34 women with an average age of 34.6 ± 10.5 years and a body mass index (BMI) of 45 kg/m2 ± 3.2) that underwent percutaneous CT-guided drainage of gastric leaks due to sleeve gastrectomy from September 2011 to September 2018
Percutaneous CT-guided drainage of gastric leaks after sleeve gastrectomy is a safe, effective, and minimally invasive alternative to surgery. This technique is in line with other conservative measures, which heal most gastric leaks due to sleeve gastrectomy and prevent the need for revisional surgery
The aim of this study is to evaluate the safety and efficacy of computed tomography (CT)-guided percutaneous drainage of post-laparoscopic sleeve gastrectomy gastric leaks
Summary
The reported rate of gastric leak after laparoscopic sleeve gastrectomy is 1% - 3%. As more laparoscopic sleeve gastrectomies are being performed, more associated gastric leaks are being encountered. No established standard management protocol exists to date [4] [5], conservative minimal invasive management is encouraged over surgical revision, as surrounding inflammation and friable tissue decrease the success rate of surgical closure of leaks [4] [6]. Surgical management is suitable for unstable septic patients with early leaks [4] [5] [6], whereas conservative management is suitable for hemodynamically stable patients and consistent of adequate collection drainage, enteral hyperalimentation, and antibiotic therapy [4]
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