Risk of Leaks After Gastric Sleeve

Surgeon response to "Risk of Leaks After Gastric Sleeve"

by: John Rabkin, M.D., Pacific Laparoscopy

Kate,

The majority of the leaks encountered after a sleeve gastrectomy are noted within the first three days following the surgery; almost all are detected within the first 30 days following surgery.

Nearly 90% of the leaks are located within the upper third of the stomach, particularly around where the esophagus joins the stomach.

Surgeons who perform this procedure need to be particularly careful when stapling this upper portion of the stomach in order to avoid leaks. In a meta-analysis of 15 published series including 1021 patients who had undergone the sleeve gastrectomy, Aurora et. al. found that the leak rates varied from 0% to 8% with an overall average of 2.8%.

Most of these leaks were managed non-operatively (without the need for additional surgery).

Importantly, they found no difference in the leak rates between patients whose surgeons used staple line reinforcement materials and those who didn't use staple line reinforcing materials (which many surgeons believe will decrease the leak rates).

In another Med-line data meta-analysis also by Aurora published in 2012 now encompassing 4888 patients who had undergone the sleeve gastrectomy, an overall leak rate of 2.4% was found, again with no difference between patients whose surgeons used staple line reinforcement and those who didn't.

What this analysis did note, however, was a dramatic difference in leak rates between those whose sleeves were constructed around a Bougie dilator (a tube placed through the mouth into the stomach during the surgery used to size the stomach during construction of the sleeve) size of 40F or greater: the leak rate was 0.6% versus 2.8% in those who used a dilator of less than 40F.

The implied message is that perhaps using a larger Bougie is safer (although perhaps resulting in a larger capacity sleeve possibly resulting in less overall weight loss over time as a result).

Leaks following sleeve gastrectomies are, for the most part, a 'technical issue' related to your surgeon's technical ability and technique.

There is little you as a patient can do to avoid a leak aside from following your surgeon's explicit post-operative instructions exactly, not smoking, and avoiding aspirin and non-steroidal anti-inflamatory medications such as Motrin/Advil/etc. during the post-operative healing phase for at least the initial six weeks following surgery.

John M. Rabkin,
M.D.Pacific Laparoscopy

(click here for Dr. Rabkin's full bio & contact info)

DISCLAIMER: This educational advice is based on the depth of your question and the details provided. The above should never replace the advice of your local physicians as they have the ability to evaluate you in person.

Related Pages:
- Gastric Sleeve Complications
- Gastric Sleeve Procedure
- Gastric Sleeve Vs. Other Types of Bariatric Surgery