Sleeve Gastrectomy Leaks: The Way we Treat it

Abstract

endoscopic clips and endoscopic suturing are new techniques not part of the algorithm that are becoming more widely used with positive results [10-13]. When other conservative methods have failed, RYGB or Roux-en-Y fistula jejunostomy have also been proposed as alternative treatments for non-healing gastric leaks [9,14-17]. With the increasing experience of surgeons performing LVSG and treating complications, Nedelcu has recently proposed an algorithm for treatment based on size of the leak and stenosis of the sleeve [18]. The aim of this study was to review our experience and outcomes of LVSG treatment and design an algorithm of successful treatment. Approval for this study was granted by the Banner Health institutional review board. Patients were identified from the authors’ prospectively maintained bariatric database. All patients between 2012 and 2014 were reviewed, and 11 patients were identified and treated at our institution. Data collected included patient demographics, operative, endoscopic and medical interventions, and follow-up outcomes. Patient demographics included age, sex, body mass index (BMI), co-morbidities, number of days from initial surgery until recognition of leak. Operative data included location of initial surgical intervention, need for repeat interventions and type, placement of feeding jejunostomy tube. Endoscopic interventions included use of OVESCO ® over the scope clip, Boston Scientific fully covered WallFlex™ esophageal stent, Apollo Over Stitch™. Post-operative data included need for multiple interventions, nutritional support, and number of days until resolution of leak. During the study period from 2012-2014, 556 patients underwent LVSG for the treatment of morbid obesity. We identified a total of 8 LVSG leaks (1.4%). Three patients did not have initial surgery at our institution and were transferred from an outside hospital for further treatment.