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Prevalence and Management of Gastric Leakage After Laparoscopic Sleeve Gastrectomy: A Case Study in Modarres Hospital, Tehran, Iran

Nasser Malekpour Alamdari, Alireza Shafiee, Maryam Abbasi, Sara Besharat




Background: Sleeve gastrectomy is an effective procedure for weight loss. However, some serious complications may occur during this operation such as strictures, bleeding, and leak. According to previous studies, the rate of leak was 1.06%. Using endoscopic stents have been hampered by some drawbacks the most important of which is repeated migration. The current study aimed to discuss the prevalence and management of leak after laparoscopic sleeve gastrectomy operated at Modarres Hospital, Tehran, Iran.
Methods: This cross-sectional study was conducted on patients with morbid obesity undergone laparoscopic sleeve gastrectomy at Modarres Hospital, Tehran, Iran. In addition to the patients’ demographic data; their leak complications, first symptoms and signs, WBC count, and method of management were extracted and collected from their medical files.
Results: A total number of 1263 patients were enrolled in this study. Of them 8(0.63%) patients suffered from leak after the operation. The mean (SD) age of patients with leak was 32.33(6.02) year. The mean (SD) BMI of patients with leak was 45.75(2.07) kg/m2. The mean (SD) of WBC count of the patients with leak was 13680(7272.68). The symptoms of the patients began on different days (3-240 day). Management of the patients was different but most of the patients underwent endoscopic stent.
Conclusion: It seems that stent insertion is a useful method for treatment of leak after sleeve gastrectomy, especially in immediate leak.


Anastomotic leakage, Laparoscopy, Gastrectomy, Bariatric surgery, Endoscopic stent


Chang S-H, Stoll CR, Song J, Varela JE, Eagon CJ, Colditz GA. The effectiveness and risks of bariatric surgery: An updated systematic review and meta-analysis, 2003-2012. JAMA Surgery. 2014; 149(3):275-87. [DOI:10.1001/jamasurg.2013.3654]

Kehagias I, Zygomalas A, Karavias D, Karamanakos S. Sleeve gastrectomy: Have we finally found the holy grail of bariatric surgery? A review of the literature. European Review for Medical and Pharmacological Sciences. 2016; 20(23):4930-42. [PMID]

Lalor PF, Tucker ON, Szomstein S, Rosenthal RJ. Complications after laparoscopic sleeve gastrectomy. Surgery for Obesity and Related Diseases. 2008; 4(1):33–8. [DOI:10.1016/j.soard.2007.08.015] [PMID]

Rosenthal RJ, Diaz AA, Arvidsson D, Baker RS, Basso N, Bellanger D, et al. International sleeve gastrectomy expert panel consensus statement: Best practice guidelines based on experience of >12,000 cases. Surgery for Obesity and Related Diseases. 2012; 8(1):8-19. [DOI:10.1016/j.soard.2011.10.019]

de Aretxabala X, Leon J, Wiedmaier G, Turu I, Ovalle C, Maluenda F et al. Gastric leak after sleeve gastrectomy: Analysis of its management. Obesity Surgery. 2011; 21(8):1232-7. [DOI:10.1007/s11695-011-0382-5]

Swinnen J, Eisendrath P, Rigaux J, Kahegeshe L, Lemmers A, Le Moine O, Devière J. Self-expandable metal stents for the treatment of benign upper GI leaks and perforations. Gastrointestinal Endoscopy. 2011; 73(5):890-9. [DOI:10.1016/j.gie.2010.12.019]

Bege T, Emungania O, Vitton V, Ah-Soune P, Nocca D, Noël P et al. An endoscopic strategy for management of anastomotic complications from bariatric surgery: A prospective study. Gastrointestinal Endoscopy. 2011; 73(2):238-44. [DOI:10.1016/j.gie.2010.10.010]

van Boeckel PG, Sijbring A, Vleggaar FP, Siersema PD. Systematic review: Temporarystent placement forbenign rupture oranastomotic leakof the oesophagus. Alimentary Pharmacology & Therapeutics. 2011; 33(12):1292-301. [DOI:10.1111/j.1365-2036.2011.04663.x]

World Medical Association. World medical association declaration of Helsinki: Ethical principles for medical research involving human subjects. Bulletin of the World Health Organization. 2001; 79(4):373.

Alamdari NM, Abdolhoseini M, Askarpour H, Bakhtiyari M. Evaluating the effect of staple line reinforcement on reducing the complications of laparoscopic sleeve gastrectomy: A randomized clinical trial. Acta Medica Iranica. 2018; 56(5):334-40.

Alamdari NM, Bakhtiyari M, Gholizadeh B, Shariati C. Analgesic effect of intraperitoneal bupivacaine hydrochloride after laparoscopic sleeve gastrectomy: A randomized clinical trial. Journal of Gastrointestinal Surgery. 2018; 22(3):396–401. [DOI:10.1007/s11605-017-3659-8]

Peel AL, Taylor EW. Proposed definitions for the audit of postoperative infection: A discussion paper. Surgical Infection Study Group. Annals of The Royal College of Surgeons of England. 1991; 73(6): 385–388. [PMID] [PMCID]

Burgos AM, Braghetto I, Csendes A, Maluenda F, Korn O, Yarmuch J, et al. Gastric leak after laparoscopic-sleeve gastrectomy for obesity. Obesity Surgery. 2009; 19(12):1672-7. [DOI:10.1007/s11695-009-9884-9]

Márquez MF, Ayza MF, Lozano RB, Morales Mdel M, Díez JM, Poujoulet RB. Gastric leak after laparoscopic sleeve gastrectomy. Obesity Surgery. 2010; 20(9):1306-11. [DOI:10.1007/s11695-010-0219-7]

Kolakowski S, Kirkland ML, Scuricht AL. Routine postoperative upper gastrointestinal series after Roux-en-Y gastric bypass. The Archives of Surgery. 2007; 142(10):930-4. [DOI:10.1001/archsurg.142.10.930]

Praveenraj P, Gomes RM, Kumar S, Senthilnathan P, Parthasarathi R, Rajapandian S, et al. Management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity: A tertiary care experience and design of a management algorithm. Journal of Minimal Access Surgery. 2016; 12(4):342–9. [DOI:10.4103/0972-9941.181285]

Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: A systematic analysis of 4,888 patients. Surgical Endoscopy. 2012; 26(6):1509–15. [DOI:10.1007/s00464-011-2085-3]

Sarkhosh k, Birch DW, Sharma A, Karmali S, Complications associated with laparoscopic sleeve gastrectomy for morbid obesity: A surgeon’s guide. Canadian Journal of Surgery. 2013; 56(5):347–52. [DOI:10.1503/cjs.033511]

Baker RS, Foote J, Kemmeter P, Brady R, Vroegop T, Serveld M. The science of stapling and leaks. Obesity Surgery. 2004; 14(10):1290-8. [DOI:10.1381/0960892042583888]

Guzaiz N, Arabi M, Khankan A, Salman R, Al-Toki M, Qazi S et al. Gastroesophageal stenting for the management of post sleeve gastrectomy leak: A single institution experience. Saudi Medical Journal. 2016; 37(12):1339–1343. [DOI:10.15537/smj.2016.12.15761]

El-Sayes IA, Frenken M, Weiner RA. Management of leakage and stenosis after sleeve gastrectomy. Surgery. 2017; 162(3):652-61. [DOI:10.1016/j.surg.2017.04.015]

DOI: https://doi.org/10.22037/ijmtfm.v8i2(Spring).20995