gms | German Medical Science

Background: Sleeve gastrectomy (SG) is one of the most popular bariatric procedures worldwide. Leakage and stenosis are associated serious complications. Hereby we displayed our management plans for leakage and/or stenosis after SG.

Materials and methods: From May 2009 through September 2014, fifty patients had SG and presented with post SG complications and had in our registry sufficient data for a retrospective statistical analysis. 25 patients (50%) were referred from other facilities.

Results: Among 50 patients (33 F), at the time of SG the mean age was 50±10.9 (20-67) years, mean body weight was 151.4± 29 (97-240) kg and mean BMI was 51.2±8.1 (38-66.6) kg/m2. 27 patients (54%) presented with leakage. 13 patients (26%), with stenosis and 9 patients with leakage and stenosis. 1 patient (2%) presented with peri-sleeve hamatoma and was excluded from analysis. Leakage was the most common complication (86%, 6 patients) in the first 5 post-operative days, showing a decreasing incidence thereafter (2 patients, 22% three months after SG). Whereas stenosis was not reported in the first 5 post-SG days and was the most common complication three months after SG (5 patients, 56 %). 19 patients (39%) were treated within 10 days after the diagnosis of complication. 23 patients with leakage (85%) were managed through minimal intervention (drainage with or without stenting), 4 patients (15%) through RYGB (3 patients) and 1 patient through oesophagojejunostomy. 2 patients with stenosis (15%) responded to repair surgery, while rescue surgery was needed in 11 patients (RYGB=10 patients, bipartition=1 patient). In the mixed group, 7 patients (80%) required rescue interventions (RYGB in 4 patients, bipartition in 2 patients and ooesophagojejunostomy in 1 patient). All patients showed complete cure, except one patient (2%).

Conclusion: The type of the complication plays a major role in choosing the optimal treating modality. The longer the time interval between SG and the development of the complication, the higher the incidence of stenosis and the lower the incidence of leakage. In patients with leakage, laparoscopic approach seems to be feasible in experienced hands. Moreover, conservative procedures (drainage and stenting) seem to achieve very satisfactory results in those patients, even in chronic leakage. Patients with stenosis or leakage mixed with stenosis benefit more from rescue surgical intervention and are amenable for laparoscopic management in experienced hands.