Management of gastric leaks after sleeve gastrectomy with endoluminal vacuum (E-Vac) therapy

Abstract

Background: Sleeve gastrectomy has become a popular weight loss procedure, but it is associated with staple line leak resulting in high morbidity and mortality. Current management options range from endoscopic techniques (predominantly stent placement) to surgical intervention.

Objective: The purpose of this study was to recognize endoluminal vacuum (E-Vac) therapy as a viable option for use in anastomotic leaks of sleeve gastrectomies.

Setting: This study took place at Baylor University Medical Center at Dallas, Texas.

Methods: Retrospective and prospectively gathered registries for use of E-Vac therapy were queried to identify 35 patients. Using upper gastrointestinal series (UGI) and esophagogastroduodenoscopy, 9 of these patients were identified with a staple line leak from laparoscopic sleeve gastrectomy (LSG). E-Vac therapy was used to resolve the leak.

Results: Nine patients were treated with E-Vac therapy. Eight of 9 patients were admitted from outside hospitals with a mean of 61 days (5-233) after LSG. During treatment, an average of 10.3 procedures per patient was done to place and exchange the Endo-SPONGE. All 9 patients had resolution of leaks confirmed by upper gastrointestinal series, after undergoing E-Vac therapy for an average of 50 days. Six of 9 patients had laparoscopic procedures before their admission. During admission, 5 of the 9 patients had self-expanding metal stents placed with failure of leak resolution. Discharge disposition included 2 patients sent to rehabilitation facilities, 1 death not attributable to E-Vac, and 6 patients went home.

Conclusion: E-Vac therapy is a viable option for patients with staple line leak after LSG.

Keywords: Complications of bariatric surgery; Endo-SPONGE; Endoluminal vacuum therapy; Perforation; Sleeve leak.