Management of Leakage After Sleeve Gastrectomy: Outcome, Treatment Algorithm, and Predictors of Resolution

Background Laparoscopic sleeve gastrectomy (LSG), which is increasing in popularity, is associated with certain complications. One of the most dreaded complications following LSG is a leakage from the staple line. Therefore, it is mandatory for surgeons to be alert to the risk factors of leakage and to be familiar with the leakage treatment choices. The aim of this study is to assess the post-LSG leakage rate, predictors of leakage, and present the treatment algorithm and its outcomes. Methods This retrospective cohort study included patients who underwent LSG at our institution during the period from 2018 to 2023. The diagnosis and management algorithm of leakage, as well as the outcomes of treatment, were assessed. Results Out of the included 1289 patients, leakage occurred in 14 patients (1.09%). All patients with leakage primarily received supporting treatment. Finally, the leak resolution rate was 92.86% (13/14). Leakage-management complications occurred in four patients (28.57%), all of whom required ICU admission. Regression analysis showed that higher BMI was the only significant predictor of non-resolution after initial treatment (p<0.001), while smoking (p = 0.002) and diabetes mellitus (p = 0.009) were the predictors of leakage occurrence. Conclusion The treatment algorithm used in the current study proved effective in managing post-LSG leakage, despite the occurrence of some complications. Computed tomography (CT) and endoscopy demonstrated a complementary diagnostic role in accurately identifying leaks. Smoking and diabetes mellitus were identified as predictors of leakage occurrence, while higher BMI was significantly associated with non-resolution of leakage after initial treatment.