Our Summary

This research studied how to treat a common complication following a certain type of weight loss surgery (laparoscopic sleeve gastrectomy), called gastric leakage. This issue was seen in 69 out of 4294 patients who had the surgery between 2010 and 2018.

The study found that most patients experienced leakage roughly six days after surgery, with the majority of leaks occurring in the upper part of the stomach. The average size of the leaks was 6.5 mm. Patients with smaller leaks recovered more quickly.

The researchers then compared two different treatment methods: surgery, or using a self-expandable metal stent (a type of device used to open up a blocked or narrowed area). They found that the stent treatment resulted in quicker recovery times and a higher rate of complete resolution compared to surgery.

However, for patients with very small and symptomless leaks, a conservative (“wait-and-see”) approach was successful almost 90% of the time. But if there was a collection of fluid around the stomach, or if damage to an organ was suspected, surgery was necessary.

In almost 40% of cases, a second treatment was needed if the first didn’t work. The researchers concluded that the stent seems to be the best option for treating larger leaks.

FAQs

  1. What is gastric leakage and how common is it after laparoscopic sleeve gastrectomy?
  2. What are the treatment methods for gastric leakage after weight loss surgery and which one is found to be most effective?
  3. Under what circumstances is a second treatment necessary for gastric leakage?

Doctor’s Tip

A doctor may advise a patient considering gastric sleeve surgery to be aware of the potential risk of gastric leakage and to discuss treatment options with their healthcare provider. They may also emphasize the importance of closely monitoring for any symptoms of leakage, such as abdominal pain, fever, or rapid heart rate, and seeking prompt medical attention if any concerns arise. Additionally, they may recommend following post-operative care instructions closely to reduce the risk of complications.

Suitable For

Patients who are typically recommended for gastric sleeve surgery are those who have a body mass index (BMI) of 40 or higher, or a BMI of 35 or higher with obesity-related health conditions such as diabetes, high blood pressure, or sleep apnea. Patients should also have tried and failed to lose weight through diet and exercise before considering surgery. Additionally, patients should be committed to making lifestyle changes post-surgery to ensure long-term success.

Timeline

Before the gastric sleeve surgery, a patient typically undergoes a series of consultations with a bariatric surgeon, completes pre-operative testing and preparation, and may be required to follow a specific diet and exercise regimen to prepare for the surgery. The surgery itself is usually performed laparoscopically and involves removing a portion of the stomach to create a smaller, sleeve-shaped stomach pouch.

After the surgery, patients are typically monitored closely for any complications, such as gastric leakage. If a leak occurs, it is usually detected within a few days to a week after the surgery, and the patient may experience symptoms such as fever, abdominal pain, and increased heart rate.

Treatment options for gastric leakage may include surgery to repair the leak, or the placement of a self-expandable metal stent to help the leak heal. In some cases, a conservative approach may be taken if the leak is small and asymptomatic. However, if there are signs of infection or organ damage, surgery is usually necessary.

Overall, the timeline for a patient before and after gastric sleeve surgery involves thorough preparation and monitoring before the surgery, followed by close monitoring and potential treatment for complications such as gastric leakage in the days and weeks following the surgery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about gastric sleeve surgery include:

  1. What is the risk of gastric leakage following gastric sleeve surgery?
  2. How soon after surgery is gastric leakage typically diagnosed?
  3. Where in the stomach do leaks usually occur?
  4. What is the average size of leaks that occur?
  5. How do smaller leaks differ in terms of recovery compared to larger leaks?
  6. What are the treatment options for gastric leakage, and what are the success rates of each method?
  7. What are the potential risks and benefits of using a self-expandable metal stent versus surgery for treating gastric leakage?
  8. When is surgery necessary for treating gastric leakage?
  9. What is the likelihood of needing a second treatment if the first one is not successful?
  10. Are there any specific signs or symptoms that I should watch for that may indicate a gastric leakage following surgery?

Reference

Authors: Olmi S, Cesana G, Rubicondo C, Oldani A, Uccelli M, De Carli S, Ciccarese F, Giorgi R, Villa R, Zanoni A, Ismail A. Journal: Obes Surg. 2020 Aug;30(8):3084-3092. doi: 10.1007/s11695-020-04658-2. PMID: 32382961