Management of leakage and stenosis after sleeve gastrectomy

• Published in: Surgery Vol. 162; no. 3; pp. 652 - 661
• Main Authors: El-Sayes, Islam A., Frenken, Michael, Weiner, Rudolf A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2017
• Subjects: Adult; Aged; Anastomotic Leak - physiopathology; Anastomotic Leak - surgery; Bariatric Surgery - adverse effects; Bariatric Surgery - methods; Body Mass Index; Cohort Studies; Constriction, Pathologic - etiology; Constriction, Pathologic - surgery; Developing Countries; Egypt; Female; Follow-Up Studies; Gastric Bypass - adverse effects; Gastric Bypass - methods; Humans; Laparoscopy - adverse effects; Laparoscopy - methods; Male; Middle Aged; Obesity, Morbid - diagnosis; Obesity, Morbid - surgery; Postoperative Complications - physiopathology; Postoperative Complications - surgery; Reoperation - methods; Retrospective Studies; Risk Assessment; Stomach - pathology; Treatment Outcome; Young Adult
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2017.04.015

Sleeve gastrectomy is one of the most commonly performed procedures in obesity and metabolic operation with leakage and stenosis being serious complications. The management of these complications is challenging, with different operative options available. The aim of our study was to evaluate the incidence and management strategies of leakage and stenosis after sleeve gastrectomy at our institution and to compare our outcomes with those previously reported in the literature. We conducted a retrospective analysis of the medical records of 49 patients treated for leakage and/or stenosis after laparoscopic sleeve gastrectomy at our Centre of excellence for bariatric and metabolic operation, including 25 patients referred to our department from other hospitals. Outcomes were evaluated using descriptive statistics. Our study cohort consisted of 49 obese patients, 33 females (66%), with a mean ± standard deviation age of 50 ± 11 years, and body mass index at the time of laparoscopic sleeve gastrectomy, 51 ± 8 kg/m2. Postsleeve gastrectomy leakage was identified in 27 patients (55%), stenosis in 13 (27%), and combined leakage and stenosis in 9 (18%). Leakage, stenosis, and combined leakage/stenosis were managed successfully by interventional methods in 85%, 15%, and 22% of cases, respectively. Conversion into another procedure provided a successful rescue operation for other patients. We had a 0% mortality rate. Most patients with leakage were managed successfully with interventional methods. The majority of patients with stenosis or both leakage and stenosis required rescue operation.