Enteric leaks after sleeve gastrectomy: Prevention and management

Abstract

Laparoscopic sleeve gastrectomy (LSG) is safe and effective for the treatment of morbid obesity. Leaks after LSG are rare (~1-3 %) but can result in significant morbidity. Utilizing bougie ≥40Fr may decrease leak rate without affecting overall weight loss up to 36 months postoperatively. For patients who develop leak after LSG, nutritional support and source control are cornerstones of management, including laparoscopic drainage and washout and feeding jejunostomy tube, if necessary. Most leaks resolve with endoscopic stenting. In rare cases, surgery (resection with Roux-en-Y esophagojejunostomy or placement of Roux limb to the fistula) is required for definitive management.