Gastric Leak After Sleeve Gastrectomy

Gastric leak after sleeve gastrectomy

What is leak?
Leak is the most feared complication after sleeve gastrectomy and gastric bypass surgeries. Treatment of leaks that may happen after sleeve gastrectomy is more difficult due to the high pressure in the stomach. It is a leak from small openings that may occur as a result of the inability of the new form of stomach or intestinal junction to heal sufficiently. Uncontrolled fluids that should normally be in the stomach or intestines may cause serious infections. The risk of leak may be seen after all digestive system surgeries. The risk of leak after obesity surgery is 1-2% in centers with experience. For clarity, leak is similar to a ruptured appendix. It can be easily treated with appropriate treatment, and if left untreated, it may cause life-threatening infections.
How is the leak determined?
Leak symptoms are high fever, palpitations and abdominal pain. Particular attention should be given to these symptoms in the first 14 days after surgery. When symptoms are seen, it is necessary to consult your bariatric surgeon or an experienced obesity center. Early diagnosis is quite important in treatment. After the first 14 days, the risk of leak decreases to almost zero.
How is the leak treated?
In case of leak, the extent of the leak and the amount of fluid in the abdomen are evaluated first. If there is excess ascites, the surgery may be repeated. In rare cases of leak that is accumulated in certain areas of the abdomen, non-surgical treatment methods are used as evacuation via imaging-guided and endoscopic stent applications. Although the treatment of leak differs, it takes an average of 2-8 weeks. During this period, hospitalization may be required depending on the condition of the infection.
Can precautions be taken for leak?
Golden rule is the use of technically appropriate medical devices and due diligence in the prevention of leak complications. This is the job of the obesity surgeon. Technically, the method, which is used especially in sleeve gastrectomy and called double suture technique by patients, is used by many centers, including our clinic, although it is not found efficient in scientific publications. We believe that the double suture technique is quite efficient in preventing leak and limiting the leak that may happen, and we use it in all our surgeries.
Patients should fully comply with the program prepared by specialist dietitians in order to prevent leak and should not consume solid food especially in the first 14 days in order not to increase the pressure on the sutures.