Single-stage operative management of laparoscopic sleeve gastrectomy leaks without endoscopic stent placement

Leaks occur in 1.4-20 % (Bohdjalian et al., Obes. Surg. 20:535-540, 2010; Nocca et al., Obes Surg. 18:560-565, 2008; Stroh et al., 19:632-640, 2009; Aurora et al., Surg. Endosc. 26:1509-1515, 2012) of patients following laparoscopic sleeve gastrectomy (LSG). Leaks may lead to major morbidity and prolonged hospitalization. Endoscopic stent placement is a potential management strategy that needs expertise and also has recognized complications (stent migration, significant dysphagia, and failure) (Rosenthal et al., Surg. Obes Relat. Dis. 8:8-19, 2012). A standard method of managing leaks following LSG has not been established. This study aims to evaluate the outcomes of consecutive patients with leaks following LSG managed at BMI Abu Dhabi Tertiary Multidisciplinary Bariatric Surgery, Abu Dhabi, UAE.

We examined all patients presenting to BMI Abu Dhabi between February 2010 and May 2012 with leaks following LSG. Data were obtained from the hospital medical record, and IRB approval was obtained. All patients were managed by utilizing a standardized operative management strategy without the use of endoscopic stenting.

A total of five patients were referred to us for higher level of care; during the same time period, we performed 71 LSGs without a leak. Patients were optimized and resuscitated adequately before surgery. Intraoperatively, all patients had endoscopy, and a T tube was placed inside the leak if clearly identifiable. Otherwise, the leak site was drained adequately without attempting to place sutures, and a jejunostomy tube was inserted. All leaks healed following an initial period of hospital stay, followed by an outpatient period on jejunostomy tube feeding and nil per os.

Single-stage operative management of leaks after LSG utilizing a standardized operative strategy without the use of endoscopic stenting is both safe and effective.