BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is increasingly being recognised as a valid stand-alone procedure for the surgical management of morbid obesity. The leak rate from the gastric staple line ranges from 1.4% to 20%. From our experience of management of LSG leaks, we have been able to formulate an algorithm-based approach to the management of these patients. METHODS: All patients referred to our hospital within a 24-month period with a diagnosis of gastric staple line leak in the background of a previous LSG were included in the study. A retrospective case note review was undertaken for these patients and an algorithm formulated. RESULTS: There were fourteen patients in the study. There were four males and ten females. Patients were managed with a combination of laparotomy, laparoscopy, endoscopic covered stenting, percutaneous radiologically guided drainage,jejunal enteric feeding and total parenteral nutrition. In five patients, re-look laparoscopy or laparotomy with washout and drainage was performed. The remaining eight patients were managed conservatively. There were no deaths. CONCLUSIONS: Although it is often disappointing when LSG leaks do occur, with adherence to the basic tenets of the surgical management of enterocutaneous fistulae as well as early detection and a high index of suspicion, these complications can be successfully managed using an algorithm-based multi-disciplinary team approach.
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is increasingly being recognised as a valid stand-alone procedure for the surgical management of morbid obesity. The leak rate from the gastric staple line ranges from 1.4% to 20%. From our experience of management of LSG leaks, we have been able to formulate an algorithm-based approach to the management of these patients. METHODS: All patients referred to our hospital within a 24-month period with a diagnosis of gastric staple line leak in the background of a previous LSG were included in the study. A retrospective case note review was undertaken for these patients and an algorithm formulated. RESULTS: There were fourteen patients in the study. There were four males and ten females. Patients were managed with a combination of laparotomy, laparoscopy, endoscopic covered stenting, percutaneous radiologically guided drainage,jejunal enteric feeding and total parenteral nutrition. In five patients, re-look laparoscopy or laparotomy with washout and drainage was performed. The remaining eight patients were managed conservatively. There were no deaths. CONCLUSIONS: Although it is often disappointing when LSG leaks do occur, with adherence to the basic tenets of the surgical management of enterocutaneous fistulae as well as early detection and a high index of suspicion, these complications can be successfully managed using an algorithm-based multi-disciplinary team approach.
Authors: Carlos Serra; Aniceto Baltasar; Luis Andreo; Nieves Pérez; Rafael Bou; Marcelo Bengochea; Juan José Chisbert Journal: Obes Surg Date: 2007-07 Impact factor: 4.129
Authors: David Fuks; Pierre Verhaeghe; Olivier Brehant; Charles Sabbagh; Frederic Dumont; Michel Riboulot; Richard Delcenserie; Jean-Marc Regimbeau Journal: Surgery Date: 2008-09-30 Impact factor: 3.982
Authors: D Nocca; D Krawczykowsky; B Bomans; P Noël; M C Picot; P M Blanc; C de Seguin de Hons; B Millat; M Gagner; L Monnier; J M Fabre Journal: Obes Surg Date: 2008-05 Impact factor: 4.129
Authors: Manuel Ferrer Márquez; Manuel Ferrer Ayza; Ricardo Belda Lozano; María del Mar Rico Morales; Jose Miguel García Díez; Ricardo Belda Poujoulet Journal: Obes Surg Date: 2010-09 Impact factor: 4.129