Management of Leaks After Sleeve Gastrectomy

Abstract

Introduction: Leaks after sleeve gastrectomy is one of the most dreaded complications. The morbidity of the patient increases many folds with long hospital stays, has to undergo multiple procedures, and the cost of patient goes very high. It is a big financial and mental burden on the patient, health system and the operating surgeon. Objectives: Discussing management of a case of leak post Sleeve Gastrectomy using fully coated long Mega stent. Methods: An Asian male aged 26 years having a BMI of 48.3 with no co-morbidities underwent laparoscopic Sleeve Gastrectomy at our centre as per the guidelines. Patient complained of Fever on the 10th post-operative day. On evaluation was found to have raised blood counts (21,00/cmm). Patient was subjected to Oral Contrast CT Scan which did not show any leakage of dye but showed a large collection lateral to the staple line. CT guided aspiration of the collection was attempted but patient developed hemothorax on the left side and an urgent Inter costal drainage tube was inserted to drain the blood. Attempt to drain the collection laparoscopically was not possible due to dense adhesions and proximity of vital organs. So open laparotomy was done and the collection was completely drained. Naso jejunal tube was kept for the feeding. On the 5th post operative day drain showed bile in it. Urgent endoscpy was done and site of leak was identified and Fully coated long Mega stent was placed with Naso jejunal tube was placed to continue the feeding. Results: Stent was removed after 8 weeks and fistula site was completely healed. Conclusion: Leaks after sleeve gastrectomy are very difficult to manage and require multi-disciplinary approach. Intraabdominal lavage and drainage of collection with Placement of Mega stent fully coated ones is an appropriate method for management of gastric leaks.