Introduction
Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric surgery around the world. It is characterized by technical simplicity, better perioperative morbidity, and relative ease of revision. However, it is not without complications. Leakage occurs in around 1–3% of those undergoing primary LSG and around 10% in those with revisional surgery. Management plans vary considerably with a wide spectrum of options. This can range from conservative nonoperative treatment to conversion to another bariatric operation. This study aims to share our center’s experience in the management of leaks after LSG with its outcomes and adverse events and to correlate the clinical-laboratory picture with imaging modalities in patients with leaks.
Patients and methods
This is a retrospective analysis of a prospectively maintained data for patients presenting to our center with leaks after LSG. A total of 23 patients (=23) were included in this analysis. Collected data included vital data [heart rate (HR), respiratory rate (RR), and body temperature], laboratory data (total leukocyte count, C-reactive protein, and erythrocyte sedimentation rate) as well as data from pelviabdominal computed tomography scan with oral and IV contrast. Females constituted 69.6% of patients. Mean age was 43.91 ± 6.54 years and mean preoperative BMI was 44.48 ± 6.53. Patients were grouped according to treatment modality into three groups. Group I was successfully treated with conservative management. Group II underwent laparoscopic drainage and endoscopic self-expandable metallic stents. Group III patients were managed by conversion to one anastomosis gastric bypass.
Results
Median leakage time was 10 days. Early leakage (<3 days) occurred in 8.7%, intermediate leakage (3–14 days) occurred in 60.9%, and late leakage (>14 days) occurred in 30.4%. Only one patient (4.35%) had the HR, temperature, and RR within normal ranges. Elevated values of HR, temperature, and RR were recorded in 91.3%, 95.6%, and 91.3%, respectively. Group I had 0% complications. Group II patients had stent migration in 21.42% of cases and persistent vomiting in 35.71% of patients, respectively. Group III patients had bleeding in 28.57%, respiratory tract infection in 14.29%, and wound infection in 14.29%.
Conclusion
Leakage after LSG is a dreadful complication. However, with appropriate management the outcomes can be substantially improved.