Management of a Proximal and Distal Staple Line Leak Following Sleeve Gastrectomy and a Concurrent Duodenal Ulcer by Emergency Laparoscopic Conversion to a Roux-en-Y Gastric Bypass

Excerpt

Acute sleeve leak is reported to occur in 1 to 4% of patients receiving sleeve gastrectomy and is associated with significant morbidity [6]. In general, management algorithms describing the surgical treatment of acute sleeve leaks advocate for simple drainage procedures [7‐9]. Formal gastric resection or bypass with immediate reconstruction is discouraged due to the greater technical complexity and risk of anastomotic complications when the surgery is performed in the emergent compared with the elective setting [10, 11]. Simple drainage is associated with low mortality, but significant morbidity including: prolonged admission, re-operation and chronic fistulas which are difficult to manage at interval surgery [7, 12].Single-stage management of acute sleeve leaks with gastrectomy or gastric bypass with concurrent Roux-en-Y reconstruction is rarely described in the literature, but is reported to be safe, effective and definitive, particularly for the management of complex sleeve leaks [1, 2]. …