As reported by The International Federation for the Surgery of Obesity (IFSO) worldwide survey on bariatric surgery, sleeve gastrectomy has become the second most performed bariatric/metabolic procedure in the world just after gastric bypass. If we consider complications, despite a recent systematic review and meta-analysis that reported a substantial decrease in sleeve gastrectomy complication rates, leaks after sleeve gastrectomy still rate between 0 and 18%. Unlike the leaks of other types of gastrointestinal surgery, leaks after sleeve gastrectomy are challenging in diagnosis and treatment and can lead to sepsis, multiple organ failure, and even death. A standardized algorithm of diagnosis and management is still lacking. Current classification of gastric leaks is based on the time of onset and clinico-pathological aspects. Nonetheless, none of the largest series in literature report the pathogenesis of gastric leaks. Given this paucity of evidence-based data and the lack of defined guidelines, we try to examine and consider the pathogenetic factors of gastric leak to implement better treatments and predict outcomes.
Gastric Leaks after Sleeve Gastrectomy: Focus on Pathogenetic Factors
INVERSINI, DAVIDE;PAPPALARDO, VINCENZO;Carcano, Giulio
2017-01-01
Abstract
As reported by The International Federation for the Surgery of Obesity (IFSO) worldwide survey on bariatric surgery, sleeve gastrectomy has become the second most performed bariatric/metabolic procedure in the world just after gastric bypass. If we consider complications, despite a recent systematic review and meta-analysis that reported a substantial decrease in sleeve gastrectomy complication rates, leaks after sleeve gastrectomy still rate between 0 and 18%. Unlike the leaks of other types of gastrointestinal surgery, leaks after sleeve gastrectomy are challenging in diagnosis and treatment and can lead to sepsis, multiple organ failure, and even death. A standardized algorithm of diagnosis and management is still lacking. Current classification of gastric leaks is based on the time of onset and clinico-pathological aspects. Nonetheless, none of the largest series in literature report the pathogenesis of gastric leaks. Given this paucity of evidence-based data and the lack of defined guidelines, we try to examine and consider the pathogenetic factors of gastric leak to implement better treatments and predict outcomes.
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