Leak After Sleeve Gastrectomy: Updated Algorithm of Treatment

Area of Science:

• Bariatric Surgery
• Gastroenterology
• Endoscopic Interventions

Background:

• Laparoscopic sleeve gastrectomy (LSG) is a common bariatric procedure.
• Leaks following LSG remain a significant complication.
• Endoscopic treatments have evolved to manage these leaks.

Purpose of the Study:

• To evaluate an updated algorithm for endoscopic treatment of leaks after LSG.
• The algorithm incorporates septotomy with balloon dilatation and pigtail insertion.
• To assess the efficacy of this endoscopic approach in different leak scenarios.

Main Methods:

• A consecutive series of 53 patients with LSG leaks treated endoscopically were analyzed.
• Patients were categorized into three groups based on leak orifice size and acuity.
• Data collected included number of sessions, treatment duration, and healing rates.

Main Results:

• Complete healing was achieved in all patients within an average of 3.2 months.
• The average number of endoscopic sessions was 2.8.
• Only 3.8% of patients required additional interventions outside the algorithm.

Conclusions:

• The updated endoscopic algorithm, including septotomy and balloon dilatation, is effective for managing LSG leaks.
• Endoscopic management offers a valuable treatment option for post-LSG leaks.
• These techniques should be part of the standard armamentarium for bariatric endoscopic services.