Stefano Olmi1,2, Giovanni Cesana3,4, Carolina Rubicondo2, Alberto Oldani1, Matteo Uccelli1, Stefano De Carli1, Francesca Ciccarese1,2, Riccardo Giorgi1, Roberta Villa1, Adelinda Zanoni1, Ayman Ismail1. 1. Department of Surgery, S.I.C.OB. (Italian Society of Bariatric Surgery) Referral Center for Bariatric Surgery, Policlinico San Marco, 24040 Zingonia-Osio Sotto, Bergamo, Italy. 2. University of Milan, via Francesco Sforza 35, 20122, Milan, Italy. 3. Department of Surgery, S.I.C.OB. (Italian Society of Bariatric Surgery) Referral Center for Bariatric Surgery, Policlinico San Marco, 24040 Zingonia-Osio Sotto, Bergamo, Italy. giovanni.cesana@gmail.com. 4. University of Milan, via Francesco Sforza 35, 20122, Milan, Italy. giovanni.cesana@gmail.com.
Abstract
PURPOSE: To propose an algorithm of treatment for leakage after laparoscopic sleeve gastrectomy (LSG). MATERIALS AND METHODS: Sixty-nine patients who developed gastric leakage out of 4294 patients who underwent LSG from 2010 to 2018 were considered in this study. Patients' outcomes in terms of incidence of resolution and time to leakage resolution were compared by leakage characteristics and type of treatment. Three patients were lost to follow up. RESULTS: Leakage occurred in a median of 6 days from surgery, and for majority of patients (80.3%), it was in the upper part of the sleeve. The median dimension of leakage was 6.5 mm. Low level leakage resulted in a lower time of resolution (p < 0.001). Patients with clinical leakage were treated with surgery or endoscopic placement of a self-expandable metal stent (SEMS). The median time of leakage resolution was 42 days. The hospitalization time for SEMS was shorter with a 68.3% of complete resolution compared with the 29.4% of surgery. In patients with subclinical and small leakage, a conservative treatment was successful in 87.5%. Overall 39.4% of patients needed a second line treatment after that the first failed. CONCLUSION: Leakage could be treated conservatively if subclinical and < 5 mm. Surgery is mandatory if a perigastric collection is present or an organ lesion is suspected. SEMS seems to be the best option to treat high level leakage.
PURPOSE: To propose an algorithm of treatment for leakage after laparoscopic sleeve gastrectomy (LSG). MATERIALS AND METHODS: Sixty-nine patients who developed gastric leakage out of 4294 patients who underwent LSG from 2010 to 2018 were considered in this study. Patients' outcomes in terms of incidence of resolution and time to leakage resolution were compared by leakage characteristics and type of treatment. Three patients were lost to follow up. RESULTS: Leakage occurred in a median of 6 days from surgery, and for majority of patients (80.3%), it was in the upper part of the sleeve. The median dimension of leakage was 6.5 mm. Low level leakage resulted in a lower time of resolution (p < 0.001). Patients with clinical leakage were treated with surgery or endoscopic placement of a self-expandable metal stent (SEMS). The median time of leakage resolution was 42 days. The hospitalization time for SEMS was shorter with a 68.3% of complete resolution compared with the 29.4% of surgery. In patients with subclinical and small leakage, a conservative treatment was successful in 87.5%. Overall 39.4% of patients needed a second line treatment after that the first failed. CONCLUSION: Leakage could be treated conservatively if subclinical and < 5 mm. Surgery is mandatory if a perigastric collection is present or an organ lesion is suspected. SEMS seems to be the best option to treat high level leakage.
Authors: Matteo Uccelli; Simone Targa; Giovanni Carlo Cesana; Alberto Oldani; Francesca Ciccarese; Riccardo Giorgi; Stefano Maria De Carli; Stefano Olmi Journal: Updates Surg Date: 2020-08-12