Obesity Surgery

, Volume 19, Issue 12, pp 1672–1677 | Cite as

Gastric Leak After Laparoscopic-Sleeve Gastrectomy for Obesity

  • Ana Maria BurgosEmail author
  • Italo Braghetto
  • Attila Csendes
  • Fernando Maluenda
  • Owen Korn
  • Julio Yarmuch
  • Luis Gutierrez
Research Clinical



One of the most serious complications after laparoscopic sleeve gastrectomy (LSG) is gastric leak. Few publications exist concerning the treatment of gastric leak. We sought to determine by way of a prospective study the clinical presentation, postoperative course, and treatment of gastric leak after LSG for obesity.


From October 2005 to August 2008, 214 patients with different degrees of obesity underwent LSG. During surgery, each patient received saline with methylene blue by way of nasogastric tube and had a drain placed. All patients underwent radiologic study with liquid barium sulphate on postoperative day 3.


Seven patients developed gastric leak. Leak in two patients (28.6%) was diagnosed by upper gastrointestinal tract (UGI) study. Two patients had type I leak (28.6%), and five patients had type II leak (71.4%). Four patients underwent reoperation. Three patients were managed medically with enteral or parenteral feeding; the drain was maintained in situ; and collections were drained by percutaneous punctions guided by computed axial tomography. Mean hospital length of stay was 28.8 days, and time to leakage closure was 43 days after surgery.


Different ways exist to manage gastric leak, depending on the magnitude of the collection and the clinical repercussions. When treatment necessitates reintervention and is performed early, suture repair is more likely to be successful. Leakage closure time will vary.


Bariatric surgery Gastric leak Morbid obesity Sleeve gastrectomy 


  1. 1.
    Gagner M, Chu CA, Quinn T, et al. Two-stage laparoscopic biliopancreatic diversion with duodenal switch: an alternative approach to super-super morbid obesity. Sur Endosc [abstract]. 2003;16:S069.Google Scholar
  2. 2.
    Regan JP, Inabnet WB, Gagner M, et al. Early experience with two-staged laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg. 2003;13:861–4.CrossRefGoogle Scholar
  3. 3.
    Mognol P, Chosidow D, Marmuse JP. Laparoscopic sleeve gastrectomy as an initial bariatric operation for high-risk patients: initial results in 10 patients. Obes Surg. 2005;15:1030–3.CrossRefGoogle Scholar
  4. 4.
    Baltasar A, Serra C, Perez N, et al. Laparoscopic sleeve gastrectomy; a multi-purpose bariatric operation. Obes Surg. 2005;15:1124–8.CrossRefGoogle Scholar
  5. 5.
    Baltasar A, Bou R, Bengochea M, et al. Mil operaciones bariátricas. Cir Esp. 2006;79:349–55.CrossRefGoogle Scholar
  6. 6.
    Braghetto I, Korn O, Valladares H, et al. Laparoscopic sleeve gastrectomy: surgical technique, indications and clinical results. Obes Surg. 2007;17:1442–50.CrossRefGoogle Scholar
  7. 7.
    Csendes A, Diaz JC, Burdiles P, et al. Classification and treatment of anastomotic leakage after extended total gastrectomy in gastric carcinoma. Hepatogastroenterology. 1990;37:174–7.PubMedGoogle Scholar
  8. 8.
    Bruce J, Krukowski ZH, Al-Khairy G, et al. Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg. 2001;88:1157–68.CrossRefGoogle Scholar
  9. 9.
    Csendes A, Burdiles P, Burgos AM, et al. Conservative management of anastomotic leaks after 557 open gastric bypasses. Obes Surg. 2005;15:1252–6.CrossRefGoogle Scholar
  10. 10.
    Csendes A. Conservative management of anastomotic leaks. Obes Surg. 2006;16:375–6.CrossRefGoogle Scholar
  11. 11.
    Baker RS, Foote J, Kemmeter P, et al. The science of stapling and leaks. Obes Surg. 2004;14:1290–4.CrossRefGoogle Scholar
  12. 12.
    Dubay DA, Franz MG. Acute wound healing: the biology of acute wound failure. Surg Clin North Am. 2003;3:463–81.CrossRefGoogle Scholar
  13. 13.
    Carucci LR, Turner MA, Conklin RC, et al. RYGB surgery for morbid obesity: evaluation of postoperative extraluminal leaks with upper gastrointestinal series. Radiology. 2006;238:119–27.CrossRefGoogle Scholar
  14. 14.
    Han SM, Kim WW, Oh J. Results of laparoscopic sleeve gastrectomy at 1 year in morbidly obese Korean patients. Obes Surg. 2005;15:1469–75.CrossRefGoogle Scholar
  15. 15.
    Hamoui N, Anthone GJ, Kaufman HS, et al. Sleeve gastrectomy in the high-risk patient. Obes Surg. 2006;16:1445–9.CrossRefGoogle Scholar
  16. 16.
    Roa PE, Kaidar-Person O, Pinto D, et al. Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short-term outcome. Obes Surg. 2006;16:1323–6.CrossRefGoogle Scholar
  17. 17.
    Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006;20:859–63.CrossRefGoogle Scholar
  18. 18.
    Weiner RA, Weiner S, Pomhoff I, et al. Laparoscoic sleeve gastrectomy—influence of sleeve size and resected gastric volume. Obes Surg. 2007;17:1297–305.CrossRefGoogle Scholar
  19. 19.
    Melissas J, Koukouraki S, Askoxylakis J, et al. Sleeve gastrectomy—a restrictive procedure? Obes Surg. 2007;17:57–62.CrossRefGoogle Scholar
  20. 20.
    Felberbauer FX, Langer F, Shakeri-Manesch S, et al. Laparoscopic sleeve gastrectomy as an isolated bariatric procedure: intermediate-term results from a lage series in three Austrian centers. Obes Surg. 2008;18:814–8.CrossRefGoogle Scholar
  21. 21.
    Tucker ON, Szomstein S, Rosenthal RJ. Indications for sleeve gastrectomy as a primary procedure for weight loss in the morbidly obese. J Gastrointest Surg. 2008;12:662–7.CrossRefGoogle Scholar
  22. 22.
    Csendes A, Maluenda F. Morbimortality of bariatric surgery. Chilean experience in 10 surgical centres. Rev Chil Cir. 2006;58:208–12.Google Scholar
  23. 23.
    Hamilton EC, Sims TL, Hamilton TT, et al. Clinical predictors of leak after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc. 2003;17:679–84.CrossRefGoogle Scholar
  24. 24.
    Deitel M, Crosby RD, Gagner M. The First International Consensus Summit for Sleeve Gastrectomy (SG), New York City, October 25–27, 2007. Obes Surg. 2008;18:487–96.CrossRefGoogle Scholar
  25. 25.
    Yehoshua RT, Eidelman LA, Stein M, et al. Laparoscopic sleeve gastrectomy—Volume and pressure assessment. Obes Surg. 2008;18:1083–8.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2009

Authors and Affiliations

  • Ana Maria Burgos
    • 1
    Email author
  • Italo Braghetto
    • 1
  • Attila Csendes
    • 1
  • Fernando Maluenda
    • 1
  • Owen Korn
    • 1
  • Julio Yarmuch
    • 1
  • Luis Gutierrez
    • 1
  1. 1.Department of SurgeryUniversity Hospital University of ChileSantiagoChile

Personalised recommendations