American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

High Maintenance Required for Persistently Leaky Gastric Sleeves

OCTOBER 29, 2019 
Clinical Congress Daily Highlights, Tuesday First Edition

For people who have had a sleeve gastrectomy, leaks are especially concerning. While only 1–3 percent of sleeves leak, these leaks are associated with high morbidity. Determining the best way to manage leaks is difficult, given the lack of randomized trials. Christina Weed, MD, Virginia Mason Medical Center, Seattle, WA, described management strategies for 30 patients with leaking sleeves who were referred to her center between 2011 and 2018. 

Median age of the analyzed group was 46 years, and 90 percent were women. A third of the bariatric procedures had been performed in Mexico. 

Management strategies varied, but over half of cases involved stenting, internal pigtail drains, and interventional radiological drainage. Less commonly used strategies included endoscopic clips/suturing and endoscopic sponge therapy. Treatments have evolved over time to include more internal drainage and endoscopic sponge procedures. 

The leaks resolved in 70 percent of cases, within a median of 220 days. One death occurred, and six leaks persisted. 

Dr. Weed showed that patients whose leaks did not resolve were more likely to require additional surgery. And over half had been prescribed narcotics within the past year. The implications are not yet clear. “The increased percentage of patients requiring operative intervention in the unresolved category is an interesting finding and one that we’re still looking at,” she said. “The surgeries happened at various times throughout the clinical course for each patient, and we don’t have many patients in the cohort to draw many conclusions.” 

She also saw that the group with continuing leaks had more endoscopies than the group whose leaks resolved. “I think that number is higher and climbing, as they are continuing to receive endoscopic interventions for their leaks,” she said. “The next step is to figure out who these patients are and why their leaks aren’t healing so we can prevent the need for so many interventions.” 

Additional Information: 
The Scientific Forum, Bariatric/Foregut II – Characteristics and Management of Laparoscopic Sleeve Gastrectomy Leaks, was held Tuesday, October 29 at the American College of Surgeons Clinical Congress 2019 in San Francisco (program, webcast and audio information).