Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients
Introduction Sleeve gastrectomy has become a popular stand-alone bariatric procedure with comparable weight loss and resolution of comorbidities to that of laparoscopic gastric bypass. The simplicity of the procedure and the decreased long-term risk profile make this surgery more appealing. Nonethel...
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| Veröffentlicht in: | Surgical endoscopy 2012-06, Vol.26 (6), p.1509-1515 |
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| creator | Aurora, Alexander R. Khaitan, Leena Saber, Alan A. |
| description | Introduction
Sleeve gastrectomy has become a popular stand-alone bariatric procedure with comparable weight loss and resolution of comorbidities to that of laparoscopic gastric bypass. The simplicity of the procedure and the decreased long-term risk profile make this surgery more appealing. Nonetheless, the ever present risk of a staple-line leak is still of great concern and needs further investigation.
Methods
An electronic literature search of MEDLINE database plus manual reference checks of articles published on laparoscopic sleeve gastrectomy for morbid obesity and its complications was completed. Keywords used in the search were “sleeve gastrectomy” OR “gastric sleeve” AND “leak.” We analyzed 29 publications, including 4,888 patients. We analyzed the frequency of leak after sleeve gastrectomy and its associated risks of causation.
Results
The risk of leak after sleeve gastrectomy in all comers was 2.4%. This risk was 2.9% in the super-obese [body mass index (BMI) > 50 kg/m
2
] and 2.2% for BMI |
| doi_str_mv | 10.1007/s00464-011-2085-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1013918790</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2660964281</sourcerecordid><originalsourceid>FETCH-LOGICAL-c468t-7f417c2adf67a65ff8b3a6a4317c77cb7a7bdceed24fd2f4ec55828e218ef5b93</originalsourceid><addsrcrecordid>eNp10F1LHTEQBuBQlHrU_oDeSEAEL1zN126y3om0VRAstL1eZrMTu7ofx8yewvn35rCnrQheBWaeSTIvY5-lOJdC2AsSwhQmE1JmSrg80x_YQhqtMqWk22ELUWqRKVuaPbZP9CgSL2X-ke2lfqpasWDff3SIf5A_AE0R_TT2aw5Dw6ffyGNLT3wMvEN4uuTAaU0T9jC1PhHo1tTSpm3OnHN8meo4THTIdgN0hJ-25wH79fXLz-ub7O7-2-311V3mTeGmzAYjrVfQhMJCkYfgag0FGJ2q1vragq0bj9goExoVDPo8d8phWgxDXpf6gJ3O9y7j-LxCmqq-JY9dBwOOK6qkkLqUzpYi0eM39HFcxbTBrArttJVJyVn5OBJFDNUytj3EdULVJu5qjrtKcVebuCudZo62N6_qHpt_E3_zTeBkC4A8dCHC4Fv67_LSSWOL5NTsKLWGB4yvv_je6y-jxpYe</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1013638371</pqid></control><display><type>article</type><title>Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Aurora, Alexander R. ; Khaitan, Leena ; Saber, Alan A.</creator><creatorcontrib>Aurora, Alexander R. ; Khaitan, Leena ; Saber, Alan A.</creatorcontrib><description>Introduction
Sleeve gastrectomy has become a popular stand-alone bariatric procedure with comparable weight loss and resolution of comorbidities to that of laparoscopic gastric bypass. The simplicity of the procedure and the decreased long-term risk profile make this surgery more appealing. Nonetheless, the ever present risk of a staple-line leak is still of great concern and needs further investigation.
Methods
An electronic literature search of MEDLINE database plus manual reference checks of articles published on laparoscopic sleeve gastrectomy for morbid obesity and its complications was completed. Keywords used in the search were “sleeve gastrectomy” OR “gastric sleeve” AND “leak.” We analyzed 29 publications, including 4,888 patients. We analyzed the frequency of leak after sleeve gastrectomy and its associated risks of causation.
Results
The risk of leak after sleeve gastrectomy in all comers was 2.4%. This risk was 2.9% in the super-obese [body mass index (BMI) > 50 kg/m
2
] and 2.2% for BMI < 50 kg/m
2
. Staple height and use of buttressing material did not affect leak rate. The use of a size 40-Fr or greater bougie was associated with a leak rate of 0.6% compared with those who used smaller sizes whose leak rate was 2.8%. Leaks were found at the proximal third of the stomach in 89% of cases. Most leaks were diagnosed after discharge. Endoscopic management is a viable option for leaks and was documented in 11% of cases as successful.
Conclusions
Sleeve gastrectomy has become an important surgical option for the treatment of the ever growing morbidly obese population. The risk of leak is low at 2.4%. Attention to detail specifically at the esophagogastric junction cannot be stressed enough. Careful patient selection (BMI < 50 kg/m
2
) and adopting the use of a 40-Fr or larger bougie may decrease the risk of leak. Vigilant follow-up during the first 30 days is critical to avoid catastrophe, because most leaks will happen after patient discharge.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-011-2085-3</identifier><identifier>PMID: 22179470</identifier><identifier>CODEN: SUREEX</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Abdominal Surgery ; Adult ; Biological and medical sciences ; Blood Loss, Surgical ; Body Mass Index ; Electronic literature ; Gastrectomy - adverse effects ; Gastrectomy - methods ; Gastric Bypass - methods ; Gastroenterology ; Gastrointestinal surgery ; General aspects ; Gynecology ; Hepatology ; Humans ; Keywords ; Laparoscopy ; Medical sciences ; Medicine ; Medicine & Public Health ; Obesity ; Obesity, Morbid - surgery ; Patients ; Proctology ; Risk Factors ; Stomach ; Stomach, duodenum, intestine, rectum, anus ; Surgeons ; Surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the digestive system ; Surgical Stapling - adverse effects ; Surgical Wound Dehiscence - etiology ; Sutures ; Weight control ; Weight Loss</subject><ispartof>Surgical endoscopy, 2012-06, Vol.26 (6), p.1509-1515</ispartof><rights>Springer Science+Business Media, LLC 2011</rights><rights>2015 INIST-CNRS</rights><rights>Springer Science+Business Media, LLC 2012</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c468t-7f417c2adf67a65ff8b3a6a4317c77cb7a7bdceed24fd2f4ec55828e218ef5b93</citedby><cites>FETCH-LOGICAL-c468t-7f417c2adf67a65ff8b3a6a4317c77cb7a7bdceed24fd2f4ec55828e218ef5b93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-011-2085-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-011-2085-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25981476$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22179470$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Aurora, Alexander R.</creatorcontrib><creatorcontrib>Khaitan, Leena</creatorcontrib><creatorcontrib>Saber, Alan A.</creatorcontrib><title>Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Introduction
Sleeve gastrectomy has become a popular stand-alone bariatric procedure with comparable weight loss and resolution of comorbidities to that of laparoscopic gastric bypass. The simplicity of the procedure and the decreased long-term risk profile make this surgery more appealing. Nonetheless, the ever present risk of a staple-line leak is still of great concern and needs further investigation.
Methods
An electronic literature search of MEDLINE database plus manual reference checks of articles published on laparoscopic sleeve gastrectomy for morbid obesity and its complications was completed. Keywords used in the search were “sleeve gastrectomy” OR “gastric sleeve” AND “leak.” We analyzed 29 publications, including 4,888 patients. We analyzed the frequency of leak after sleeve gastrectomy and its associated risks of causation.
Results
The risk of leak after sleeve gastrectomy in all comers was 2.4%. This risk was 2.9% in the super-obese [body mass index (BMI) > 50 kg/m
2
] and 2.2% for BMI < 50 kg/m
2
. Staple height and use of buttressing material did not affect leak rate. The use of a size 40-Fr or greater bougie was associated with a leak rate of 0.6% compared with those who used smaller sizes whose leak rate was 2.8%. Leaks were found at the proximal third of the stomach in 89% of cases. Most leaks were diagnosed after discharge. Endoscopic management is a viable option for leaks and was documented in 11% of cases as successful.
Conclusions
Sleeve gastrectomy has become an important surgical option for the treatment of the ever growing morbidly obese population. The risk of leak is low at 2.4%. Attention to detail specifically at the esophagogastric junction cannot be stressed enough. Careful patient selection (BMI < 50 kg/m
2
) and adopting the use of a 40-Fr or larger bougie may decrease the risk of leak. Vigilant follow-up during the first 30 days is critical to avoid catastrophe, because most leaks will happen after patient discharge.</description><subject>Abdominal Surgery</subject><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Blood Loss, Surgical</subject><subject>Body Mass Index</subject><subject>Electronic literature</subject><subject>Gastrectomy - adverse effects</subject><subject>Gastrectomy - methods</subject><subject>Gastric Bypass - methods</subject><subject>Gastroenterology</subject><subject>Gastrointestinal surgery</subject><subject>General aspects</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Keywords</subject><subject>Laparoscopy</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Obesity</subject><subject>Obesity, Morbid - surgery</subject><subject>Patients</subject><subject>Proctology</subject><subject>Risk Factors</subject><subject>Stomach</subject><subject>Stomach, duodenum, intestine, rectum, anus</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the digestive system</subject><subject>Surgical Stapling - adverse effects</subject><subject>Surgical Wound Dehiscence - etiology</subject><subject>Sutures</subject><subject>Weight control</subject><subject>Weight Loss</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp10F1LHTEQBuBQlHrU_oDeSEAEL1zN126y3om0VRAstL1eZrMTu7ofx8yewvn35rCnrQheBWaeSTIvY5-lOJdC2AsSwhQmE1JmSrg80x_YQhqtMqWk22ELUWqRKVuaPbZP9CgSL2X-ke2lfqpasWDff3SIf5A_AE0R_TT2aw5Dw6ffyGNLT3wMvEN4uuTAaU0T9jC1PhHo1tTSpm3OnHN8meo4THTIdgN0hJ-25wH79fXLz-ub7O7-2-311V3mTeGmzAYjrVfQhMJCkYfgag0FGJ2q1vragq0bj9goExoVDPo8d8phWgxDXpf6gJ3O9y7j-LxCmqq-JY9dBwOOK6qkkLqUzpYi0eM39HFcxbTBrArttJVJyVn5OBJFDNUytj3EdULVJu5qjrtKcVebuCudZo62N6_qHpt_E3_zTeBkC4A8dCHC4Fv67_LSSWOL5NTsKLWGB4yvv_je6y-jxpYe</recordid><startdate>20120601</startdate><enddate>20120601</enddate><creator>Aurora, Alexander R.</creator><creator>Khaitan, Leena</creator><creator>Saber, Alan A.</creator><general>Springer-Verlag</general><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20120601</creationdate><title>Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients</title><author>Aurora, Alexander R. ; Khaitan, Leena ; Saber, Alan A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c468t-7f417c2adf67a65ff8b3a6a4317c77cb7a7bdceed24fd2f4ec55828e218ef5b93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Abdominal Surgery</topic><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Blood Loss, Surgical</topic><topic>Body Mass Index</topic><topic>Electronic literature</topic><topic>Gastrectomy - adverse effects</topic><topic>Gastrectomy - methods</topic><topic>Gastric Bypass - methods</topic><topic>Gastroenterology</topic><topic>Gastrointestinal surgery</topic><topic>General aspects</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Keywords</topic><topic>Laparoscopy</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Obesity</topic><topic>Obesity, Morbid - surgery</topic><topic>Patients</topic><topic>Proctology</topic><topic>Risk Factors</topic><topic>Stomach</topic><topic>Stomach, duodenum, intestine, rectum, anus</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the digestive system</topic><topic>Surgical Stapling - adverse effects</topic><topic>Surgical Wound Dehiscence - etiology</topic><topic>Sutures</topic><topic>Weight control</topic><topic>Weight Loss</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Aurora, Alexander R.</creatorcontrib><creatorcontrib>Khaitan, Leena</creatorcontrib><creatorcontrib>Saber, Alan A.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Aurora, Alexander R.</au><au>Khaitan, Leena</au><au>Saber, Alan A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2012-06-01</date><risdate>2012</risdate><volume>26</volume><issue>6</issue><spage>1509</spage><epage>1515</epage><pages>1509-1515</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><coden>SUREEX</coden><abstract>Introduction
Sleeve gastrectomy has become a popular stand-alone bariatric procedure with comparable weight loss and resolution of comorbidities to that of laparoscopic gastric bypass. The simplicity of the procedure and the decreased long-term risk profile make this surgery more appealing. Nonetheless, the ever present risk of a staple-line leak is still of great concern and needs further investigation.
Methods
An electronic literature search of MEDLINE database plus manual reference checks of articles published on laparoscopic sleeve gastrectomy for morbid obesity and its complications was completed. Keywords used in the search were “sleeve gastrectomy” OR “gastric sleeve” AND “leak.” We analyzed 29 publications, including 4,888 patients. We analyzed the frequency of leak after sleeve gastrectomy and its associated risks of causation.
Results
The risk of leak after sleeve gastrectomy in all comers was 2.4%. This risk was 2.9% in the super-obese [body mass index (BMI) > 50 kg/m
2
] and 2.2% for BMI < 50 kg/m
2
. Staple height and use of buttressing material did not affect leak rate. The use of a size 40-Fr or greater bougie was associated with a leak rate of 0.6% compared with those who used smaller sizes whose leak rate was 2.8%. Leaks were found at the proximal third of the stomach in 89% of cases. Most leaks were diagnosed after discharge. Endoscopic management is a viable option for leaks and was documented in 11% of cases as successful.
Conclusions
Sleeve gastrectomy has become an important surgical option for the treatment of the ever growing morbidly obese population. The risk of leak is low at 2.4%. Attention to detail specifically at the esophagogastric junction cannot be stressed enough. Careful patient selection (BMI < 50 kg/m
2
) and adopting the use of a 40-Fr or larger bougie may decrease the risk of leak. Vigilant follow-up during the first 30 days is critical to avoid catastrophe, because most leaks will happen after patient discharge.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>22179470</pmid><doi>10.1007/s00464-011-2085-3</doi><tpages>7</tpages></addata></record> |
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| source | MEDLINE; SpringerNature Journals |
| subjects | Abdominal Surgery Adult Biological and medical sciences Blood Loss, Surgical Body Mass Index Electronic literature Gastrectomy - adverse effects Gastrectomy - methods Gastric Bypass - methods Gastroenterology Gastrointestinal surgery General aspects Gynecology Hepatology Humans Keywords Laparoscopy Medical sciences Medicine Medicine & Public Health Obesity Obesity, Morbid - surgery Patients Proctology Risk Factors Stomach Stomach, duodenum, intestine, rectum, anus Surgeons Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system Surgical Stapling - adverse effects Surgical Wound Dehiscence - etiology Sutures Weight control Weight Loss |
| title | Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients |
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