Surgical management for chronic leak following sleeve gastrectomy: Review of literature

Abstract

BackgroundThe gastric leak (GL) is estimated to be the most serious complication of the laparoscopic sleeve gastrectomy (LSG). There are several endoscopic approaches but no clear algorithm of treatment. In the case of endoscopic treatment failure, a definitive surgical approach can be attempted. ObjectivesThe purpose of the present study was to review the literature concerning the 3 different surgical approaches proposed for chronic leak and to evaluate their outcomes. SettingPrivate hospital, France. MethodsStudies of any design that involved the treatment of a leak after LSG from 2006 to 2017 were considered. Our initial analysis included a prescreen to identify the clearly irrelevant reports by title, abstract, and keywords of the publication. The extracted information included number of patients, endoscopic treatment, type of definitive corrective surgical procedure for leak and details of the intervention, rate of conversion, and postoperative outcomes. ResultsA total of 473 records were identified by the initial search, and 389 papers were excluded after screening by title and abstract. Of the remaining 84 studies, 28 were identified; 1 was excluded because it had combined LSG with ileal interposition, 1 for different language than English or French, 4 for repetitive information, and 5 for video reports or technical description. A total of 114 patients were assessed in the 12 studies, and the number of patients ranged from 3 to 21. The review included 65 cases of total gastrectomy with esojejunal anastomosis (57%), 41 cases of fistulojejunostomy (35.9%), and 8 cases of Roux en Y gastric bypass (7.1%). Leaks occurred more frequently (37.5%, 3 cases) following Roux-en-Y gastric bypass, fistulojejunostomy (21.9%, 9 cases), and esophagojejunal anastomosis (7.7%, 5 cases). The healing time for a leak following definitive reconstructive surgeries varied between 10 and 165 days. Mortality was recorded in only 1 case (0.8%). ConclusionSurgery should be considered as a failure of the endoscopic approach to treat a chronic leak after LSG. More research is needed to clearly identify the appropriate treatment of chronic leak after LSG, but it is obvious that clinicians must be aware of and prepared to treat bariatric patients who develop this dreaded complication.