Management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity: A tertiary care experience and design of a management algorithm

摘要

Background: Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed 'standalone' bariatric procedure in India. Staple linegastric leaks occur infrequently but cause significant and prolonged morbidity. The aim of this retrospective study was to analyse the managementof patients with a gastric leak after LSG for morbid obesity at our institution. Patients and Methods: From February 2008 to 2014, 650 patientswith different degrees of morbid obesity underwent LSG. Among these, all those diagnosed with a gastric leak were included in the study. Patientsreferred to our institution with gastric leak after LSG were also included. The time of presentation, site of leak, investigations performed, treatmentgiven and time of closure of all leaks were analysed. Results: Among the 650 patients who underwent LSG, 3 (0.46%) developed a gastric leak.Two patients were referred after LSG was performed at another institution. The mean age was 45.60 ± 15.43 years. Mean body mass index(BMI) was 44.79 ± 5.35. Gastric leak was diagnosed 24 h to 7 months after surgery. One was early, two were intermediate and two were lateleaks. Two were type I and three were type II gastric leaks. Endoscopic oesophageal stenting was used variably before or after re-surgery. Resurgerywas performed in all and included stapled fistula excision (re-sleeve), suture repair only or with conversion to roux-en-Y gastric bypass orfistula jujenostomy. There was no mortality. Conclusion: Leakage closure time may be shorter with intervention than expectant management.Sequence and choice of endoscopic oesophageal stenting and/or surgical re-intervention should be individualized according to clinical presentation.