GASTRIC LEAK POSSIBLE
AFTER GASTRIC SLEEVE SURGERY
Type 1 or Type 2 Leaks
- By clinical relevance and extent of dissemination, type I or sub clinical leaks are those that are well localized without dissemination into the pleural or abdominal cavity, or inducement of systemic clinical manifestations, usually, they are easy to treat medically.
- Type II leaks are leaks with dissemination into the abdominal or pleural cavity, or the drains with consequent severe and systemic clinical manifestations (Rached, Basile, & El Masri, 2014).
Type A, B or C Leaks
Based on both clinical and radiological findings, type A is micro-perforations without clinical or radiographic evidence of leak, while type B are leaks detected by radiological studies but without any clinical outcome, and finally, type Cleaks are leaks presenting with both radiological and clinical evidence (Welsch, Von Frankenberg, Schmidt, & Buchler, 2011).
The cause of gastric leak following laparoscopic gastric sleeve can either be mechanical (stapler misfiring) or ischemic. In a multicenter experience with 2834 patients, leaks post LSG included improper vascularization due to an aggressive dissection especially of the posterior attachments of the upper sleeve, thermal injuries to the gastric tube by ultrasonic devices (harmonic, Ligasure), stapler devices misfiring, stapling of the orogastric tube (Rached, Basile, & El Masri, 2014).
Depending on the type of leak, the patient may be asymptomatic or may present with fever, abdominal pain, tachycardia (increased heart rate), hypotension, and shock. Unexplained fever and tachycardia post op should raise the index of suspicion of a possible complication and push the surgeon to perform further radiological investigations to rule out the presence of a leak (Rached, Basile, & El Masri, 2014).
A gastric leak along staple line is one of the dreaded complications of gastric sleeve surgery. When it occurs, it often requires another surgery for correction, and this further prolongs the hospital stay and placed another financial burden on the patient. The condition may be life threatening if not aggressively managed. It’s important to prevent it by avoiding/minimizing the predisposing factors.
Decreasing the Chance of Gastric Sleeve Leaks
Renew Bariatrics understands patient’s fears about staple-line leaks, as they are extremely uncomfortable, and if left untreated, can be very serious. We aim to help mitigate the fear by taking the following approach to minimize the chance of getting gastric leaks for our patients. However, it’s important to know, that these steps will never adequately reduce the possibility of getting this gastric leaks. Even with our bariatric surgeon doing everything perfectly, on a healthy patient – it still won’t eliminate this risk.
Our Approach to Minimize Gastric Leaks
- We perform three leak tests – we show, over the course of your stay, three leak tests. This helps us spot any leaks that arose, or may occur after surgery.
- We suture the staple line, to ensure the stomach is properly sealed.
- We use the bougie size, that has been shown to increase patient outcomes – while minimizing complications.
- We always perform corrective surgery, if necessary.
Have more questions about what makes Renew Bariatrics different from the competitors? Contact our helpful patient care coordinators today, to learn more about our practice.
- Sarkhosh, K., Birch, D., Sharma, A., & Karmali, S. (2013, October). Complications associated with laparoscopic sleeve gastrectomy for morbid obesity: a surgeon’s guide. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3788014/
- Frezza, E. E., Reddy, S., Gee, L. L., & Wachtel, M. S. (2008, October). Complications After Sleeve Gastrectomy for Morbid Obesity. Retrieved from https://www.researchgate.net/profile/Mitch…
- Rached, A. A., Basile, M., & El Masri, H. (2014, October). Gastric leaks post sleeve gastrectomy: Review of its prevention and management. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194572/
- Welsch, T., Von Frankenberg, M., Schmidt, J., & Buchler, M. W. (2011, January). [Diagnosis and definition of anastomotic leakage from the surgeon’s perspective]. – PubMed – NCBI. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21107971
All Vertical Sleeve Gastrectomy Surgeries, Whether in México or the United States, carries the risk of staple-line leaks, but you need to ensure that you pick a top bariatric surgeon who has the necessary experience to buttress the new stomach and handle any stomach. Contact our staff to learn more today.