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Sleeve gastrectomy has become a common procedure in the field of bariatric surgery. It was initially used in the superobese to get them to a safer weight in order to undergo a more complex procedure, but many have found sufficient weight loss and resolution of comorbidities with the sleeve alone. The simplicity of the procedure and the decreased risk profile make this surgery very appealing.
However, the ever-present risk of a staple-line leak is still of great concern and needs further investigation. Gastric leakage remains the most serious complication and occurs in 1 to 3% of all cases and in as much as 7% in one case series. Gastric staple line leakage occurs most commonly in the proximal aspect of the staple line and tends to be subacute in nature. Leakage is associated with a high degree of morbidity for the patient and cost of care for institutions and payers.
Reported techniques to minimize occurrence of leakage include changes in calibration tube size, changes in staple cartridge, use of fibrin glues, oversewing of staple line, and use of staple line reinforcement materials.
This is a severe complication prolonging the hospital stay, and frequently resulting in the patient’s death. So far, no uniform and standard guidelines for management of this group of patients have been developed, and attempts at treatment of this complication cover a wide range of methods, starting with radiologically guided percutaneous drainage of fluid reservoirs forming in the leakage area, through endoscopic methods (insertion of self-expandable stents into the GI tract, use of tissue glues or special clips), and ending with attempts at sole pharmacological treatment.
In this lecture, professor Manoel Galvao provides a detailed review of the possible pathophysiological causes of the appearance of leakage after a sleeve gastrectomy, why these leaks become chronic fistulas, and the different endoscopic treatments available for their treatment.
