Early Detection and Management of Leakage after Sleeve Gastrectomy

Background: Staple line leakage is the most feared complication after laparoscopic sleeve gastrectomy (LSG). The aim of this study was to describe the rate of leakage, the clinical presentation, early diagnosis and different lines of treatment in patients who develop gastric leaks following LSG. Patients and methods:This study is a retrospective review of 849 patients who underwent LSG in AL Ahli Hospital (Qatar), and AL Amiri Hospital (Kuwait), between May, 2008 and May, 2013. The collected data included patients' demographics, operative and perioperative parameters. Results: 849 patients underwent LSG, 15 (1.8%) with gastric leak were identified; 9 females (60%) and 6 males (40%) with a mean ageof 39.5 years and a mean body mass index (BMI) of42.5 kg/m2. Tachycardia was the most common presenting symptom of leakage (80%), followed by fever (60%), left upper abdominal pain (60%) and left shoulder pain (60%). Early detection of leakage (0-3 days) was found in 12 cases (80%) and intermediate detection (4-14 days) was found in 3 cases (20%). All leaks were found in the upper sleeve near the gastro esophageal junction (100%). Re-operation was performed for 6 cases (40%), percutaneous drainage for 6 cases (40%), endoscopic placement of stents in 9 cases (60%), and endoscopic insertion of clips in 3 cases (20%). The median time for leakage closure was 25 days (10-42 days) and the overall leakage related mortality was 3 cases (20%). Conclusion: Staple line leakage is one of the complications following LSG (1.8%). Early leakage is more common than intermediate and late leaks. Tachycardia is the most common presenting symptom. Most leaks occur in the upper part of the sleeve. The management should be planned based on the clinical evaluation and time of diagnosis of leakage.