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01-08-2020 | Sleeve Gastrectomy | Original Contributions

Management of 69 Gastric Leakages after 4294 Consecutive Sleeve: The Experience of a High Volume Bariatric Center

Authors: Stefano Olmi, Giovanni Cesana, Carolina Rubicondo, Alberto Oldani, Matteo Uccelli, Stefano De Carli, Francesca Ciccarese, Riccardo Giorgi, Roberta Villa, Adelinda Zanoni, Ayman Ismail

Published in: Obesity Surgery | Issue 8/2020

Abstract

Purpose

To propose an algorithm of treatment for leakage after laparoscopic sleeve gastrectomy (LSG).

Materials and Methods

Sixty-nine patients who developed gastric leakage out of 4294 patients who underwent LSG from 2010 to 2018 were considered in this study. Patients’ outcomes in terms of incidence of resolution and time to leakage resolution were compared by leakage characteristics and type of treatment. Three patients were lost to follow up.

Results

Leakage occurred in a median of 6 days from surgery, and for majority of patients (80.3%), it was in the upper part of the sleeve. The median dimension of leakage was 6.5 mm. Low level leakage resulted in a lower time of resolution (p < 0.001). Patients with clinical leakage were treated with surgery or endoscopic placement of a self-expandable metal stent (SEMS). The median time of leakage resolution was 42 days. The hospitalization time for SEMS was shorter with a 68.3% of complete resolution compared with the 29.4% of surgery. In patients with subclinical and small leakage, a conservative treatment was successful in 87.5%. Overall 39.4% of patients needed a second line treatment after that the first failed.

Conclusion

Leakage could be treated conservatively if subclinical and < 5 mm. Surgery is mandatory if a perigastric collection is present or an organ lesion is suspected. SEMS seems to be the best option to treat high level leakage.

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Title: Management of 69 Gastric Leakages after 4294 Consecutive Sleeve: The Experience of a High Volume Bariatric Center
Authors: Stefano Olmi
Giovanni Cesana
Carolina Rubicondo
Alberto Oldani
Matteo Uccelli
Stefano De Carli
Francesca Ciccarese
Riccardo Giorgi
Roberta Villa
Adelinda Zanoni
Ayman Ismail
Publication date: 01-08-2020
Publisher: Springer US
Keyword: Sleeve Gastrectomy
Published in: Obesity Surgery / Issue 8/2020
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-020-04658-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Management of 69 Gastric Leakages after 4294 Consecutive Sleeve: The Experience of a High Volume Bariatric Center

Abstract

Purpose

Materials and Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Materials and Methods

Results

Conclusion

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