Management of 69 Gastric Leakages after 4294 Consecutive Sleeve: The Experience of a High Volume Bariatric Center
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ORIGINAL CONTRIBUTIONS
Management of 69 Gastric Leakages after 4294 Consecutive Sleeve: The Experience of a High Volume Bariatric Center Stefano Olmi 1,2 & Giovanni Cesana 1,2 & Carolina Rubicondo 2 & Alberto Oldani 1 & Matteo Uccelli 1 & Stefano De Carli 1 & Francesca Ciccarese 1,2 & Riccardo Giorgi 1 & Roberta Villa 1 & Adelinda Zanoni 1 & Ayman Ismail 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose To propose an algorithm of treatment for leakage after laparoscopic sleeve gastrectomy (LSG). Materials and Methods Sixty-nine patients who developed gastric leakage out of 4294 patients who underwent LSG from 2010 to 2018 were considered in this study. Patients’ outcomes in terms of incidence of resolution and time to leakage resolution were compared by leakage characteristics and type of treatment. Three patients were lost to follow up. Results Leakage occurred in a median of 6 days from surgery, and for majority of patients (80.3%), it was in the upper part of the sleeve. The median dimension of leakage was 6.5 mm. Low level leakage resulted in a lower time of resolution (p < 0.001). Patients with clinical leakage were treated with surgery or endoscopic placement of a self-expandable metal stent (SEMS). The median time of leakage resolution was 42 days. The hospitalization time for SEMS was shorter with a 68.3% of complete resolution compared with the 29.4% of surgery. In patients with subclinical and small leakage, a conservative treatment was successful in 87.5%. Overall 39.4% of patients needed a second line treatment after that the first failed. Conclusion Leakage could be treated conservatively if subclinical and < 5 mm. Surgery is mandatory if a perigastric collection is present or an organ lesion is suspected. SEMS seems to be the best option to treat high level leakage. Keywords Sleeve gastrectomy . Leakage . Endogastric stent . Bariatric complications
Stefano Olmi is a “Contract Professor” of the General Surgery Faculty and a teacher in the Residency Program. Giovanni Cesana and Francesca Ciccarese are “Tutor” in the General Surgery Residency Program. Carolina Rubicondo is a Resident in General Surgery. * Giovanni Cesana [email protected]
Riccardo Giorgi [email protected]
Stefano Olmi [email protected]
Roberta Villa [email protected]
Carolina Rubicondo [email protected]
Adelinda Zanoni [email protected]
Alberto Oldani [email protected]
Ayman Ismail [email protected]
Matteo Uccelli [email protected] 1
Department of Surgery, S.I.C.OB. (Italian Society of Bariatric Surgery) Referral Center for Bariatric Surgery, Policlinico San Marco, 24040 Zingonia-Osio Sotto, Bergamo, Italy
2
University of Milan, via Francesco Sforza 35, 20122 Milan, Italy
Stefano De Carli [email protected] Francesca Ciccarese [email protected]
OBES SURG
Introduction The total number of bariatric procedures worldwide is increasing, and the most performed is laparoscopic sleeve gastrectomy (LSG) [1]. Leakage is
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