Partial dehiscence of an intraoperative staple line during laparoscopic sleeve gastrectomy: A case report

Leakage along a staple line during sleeve gastrectomy is a serious complication. Mechanical causes are uncommon; however, they should be considered as sources of acute postoperative leaks. The presented case discusses an important intraoperative complication with an avoidable cause that could benefit practicing surgeons as well as residents in training programs.

This case describes the mechanical failure of a stapler that was identified intraoperatively. The staple line was oversewn using a 3-0 V Lok suture. The methylene blue test was negative, and the patient had an uneventful postoperative recovery.

While most leaks were attributed to ischemia of the upper third of the stomach, leaks occurring within the first three postoperative days have a different pathophysiology. This may involve mechanical complications (stapler failure), direct gastric tissue trauma from aggressive handling, or thermal injuries. In our case, the likely cause of the partial dehiscence was the proximity of the stapler to the bougie and an unnoticed small fold at the antrum.

Surgeons should avoid placing the stapler too close to the bougie. Furthermore, surgeons should ensure that the stomach is flat and there are no gastric folds that could lead to stapling failure.