Staple-line leak post primary sleeve gastrectomy. A two patient case series and literature review

Abstract

There is an increasing trend in the number of bariatric surgeries performed worldwide, partly because bariatric surgery is the most effective treatment for morbid obesity. Sleeve gastrectomy (SG) remains the most common bariatric surgery procedure performed, representing more than 50% of all primary bariatric interventions. Major surgical complications of SG include staple-line bleeding, leaking, and stenosis. A leak along the staple-line most commonly occurs at the gastroesophageal junction (GOJ).

From January 2018 to December 2018, our centre performed 226 bariatric procedures, of which, 97.8% were primary bariatric procedures. The mean age and BMI were 38.7±8.3 years and 44 kg/m2, respectively. Out of the 202 primary SG performed, we encountered two cases of a staple-line leak (0.99%). This is the first reported case series of SG leaks from the Southeast Asia region. A summary of their characteristics, clinical presentation, subsequent management, and the outcome is discussed.

Based on the latest available evidence from the literature, several methods may decrease staple-line leaks in SG. These include the use of a bougie size greater than 40 Fr, routine use of methylene blue test during surgery, beginning transection at 2–6 cm from the pylorus, mobilising the fundus before transection, and staying away from the GOJ at the last firing. Other methods include the proper alignment of the staple-line, control of staple-line bleeding, and performing staple-line reinforcement. The management of a staple-line leak remains challenging due to limited systematic, evidence-based literature being available. Therefore, a tailored approach is needed to manage this complication.

Highlights

• •

  Major surgical complications of sleeve gastrectomy include staple-line bleeding, leaking, and stenosis.

• •

  The incidence of leak after sleeve gastrectomy is reported to be 0.74%.

• •

  We report a leak rate of 0.99%, based on 202 sleeve gastrectomy performed in a single centre.

• •

  This is the first reported case series of SG leaks from the Southeast Asia region to the best of our knowledge.

• •

  Based on the latest available evidence from the literature, several methods may decrease staple-line leaks in SG.

• •

  It is crucial that patients with this complication are managed by a multidisciplinary team.