Gastric leakage after sleeve gastrectomy-clinical presentation and therapeutic options

To analyze gastric leakage following sleeve gastrectomy depending on its point of detection and localization in order to evaluate therapeutic strategies.

From Dec 2006 until June 2010, data of all patients undergoing bariatric surgery were entered into a prospectively documented database. Evaluation contained patient's gender, age, body mass index (BMI), type of surgery, clinical symptoms, diagnostics, onset and localization of leakage, type of therapy, length of stay (LOS), and clinical outcome.

Forty-five of 196 bariatric patients underwent sleeve gastrectomy, 22 male and 23 female with mean age 43 ± 9.7 years and mean BMI 54.9 ± 10 kg/m(2). Four patients developed a gastric leak (8.9%)-three proximal leaks and one distal leak. Leakage was detected by upper gastrointestinal (UGI) radiography in two cases, by gastroscopy in one case, and by abdominal computed tomographic (CT) scan in another case. In two cases, CT scan was not feasible because of patient's conditions. Three patients underwent relaparoscopy with re-suture of staple line, abdominal lavage, and placement of an intraabdominal drain. Both patients with proximal leaks required stent graft application as leakage reoccurred within 5 days after relaparoscopy. LOS varied between 30 and 120 days. None of the patients died.

The location of leakage, and the presence or absence of an intraabdominal drain are determining factors for its treatment. UGI radiography with contrast media and gastroscopy are comparable and superior to standard CT scan. Stent graft application is a promising therapy in case of proximal leakage; re-suture or resection of the staple line are possible solutions in case of a distal leak.