Staple-line leak post primary sleeve gastrectomy. A two patient case series and literature review

Guo Hou Loo, R. Rajan, Nik Ritza Kosai Nik Mahmood

Research output: Contribution to journalArticle

Abstract

There is an increasing trend in the number of bariatric surgeries performed worldwide, partly because bariatric surgery is the most effective treatment for morbid obesity. Sleeve gastrectomy (SG) remains the most common bariatric surgery procedure performed, representing more than 50% of all primary bariatric interventions. Major surgical complications of SG include staple-line bleeding, leaking, and stenosis. A leak along the staple-line most commonly occurs at the gastroesophageal junction (GOJ). From January 2018 to December 2018, our centre performed 226 bariatric procedures, of which, 97.8% were primary bariatric procedures. The mean age and BMI were 38.7±8.3 years and 44 kg/m2, respectively. Out of the 202 primary SG performed, we encountered two cases of a staple-line leak (0.99%). This is the first reported case series of SG leaks from the Southeast Asia region. A summary of their characteristics, clinical presentation, subsequent management, and the outcome is discussed. Based on the latest available evidence from the literature, several methods may decrease staple-line leaks in SG. These include the use of a bougie size greater than 40 Fr, routine use of methylene blue test during surgery, beginning transection at 2–6 cm from the pylorus, mobilising the fundus before transection, and staying away from the GOJ at the last firing. Other methods include the proper alignment of the staple-line, control of staple-line bleeding, and performing staple-line reinforcement. The management of a staple-line leak remains challenging due to limited systematic, evidence-based literature being available. Therefore, a tailored approach is needed to manage this complication.

Original languageEnglish
Pages (from-to)72-76
Number of pages5
JournalAnnals of Medicine and Surgery
Volume44
DOIs
Publication statusPublished - 1 Aug 2019

Fingerprint

Gastrectomy
Bariatrics
Bariatric Surgery
Esophagogastric Junction
Hemorrhage
Southeastern Asia
Morbid Obesity
Methylene Blue
Pylorus
Pathologic Constriction
Therapeutics

Keywords

  • Asian population
  • Bariatric surgery
  • Complications
  • Endoscopic stenting
  • Southeast Asia

ASJC Scopus subject areas

  • Surgery

Cite this

Staple-line leak post primary sleeve gastrectomy. A two patient case series and literature review. / Loo, Guo Hou; Rajan, R.; Nik Mahmood, Nik Ritza Kosai.

In: Annals of Medicine and Surgery, Vol. 44, 01.08.2019, p. 72-76.

Research output: Contribution to journalArticle

@article{79374bb676c442559e73bfea19c157c9,
title = "Staple-line leak post primary sleeve gastrectomy. A two patient case series and literature review",
abstract = "There is an increasing trend in the number of bariatric surgeries performed worldwide, partly because bariatric surgery is the most effective treatment for morbid obesity. Sleeve gastrectomy (SG) remains the most common bariatric surgery procedure performed, representing more than 50{\%} of all primary bariatric interventions. Major surgical complications of SG include staple-line bleeding, leaking, and stenosis. A leak along the staple-line most commonly occurs at the gastroesophageal junction (GOJ). From January 2018 to December 2018, our centre performed 226 bariatric procedures, of which, 97.8{\%} were primary bariatric procedures. The mean age and BMI were 38.7±8.3 years and 44 kg/m2, respectively. Out of the 202 primary SG performed, we encountered two cases of a staple-line leak (0.99{\%}). This is the first reported case series of SG leaks from the Southeast Asia region. A summary of their characteristics, clinical presentation, subsequent management, and the outcome is discussed. Based on the latest available evidence from the literature, several methods may decrease staple-line leaks in SG. These include the use of a bougie size greater than 40 Fr, routine use of methylene blue test during surgery, beginning transection at 2–6 cm from the pylorus, mobilising the fundus before transection, and staying away from the GOJ at the last firing. Other methods include the proper alignment of the staple-line, control of staple-line bleeding, and performing staple-line reinforcement. The management of a staple-line leak remains challenging due to limited systematic, evidence-based literature being available. Therefore, a tailored approach is needed to manage this complication.",
keywords = "Asian population, Bariatric surgery, Complications, Endoscopic stenting, Southeast Asia",
author = "Loo, {Guo Hou} and R. Rajan and {Nik Mahmood}, {Nik Ritza Kosai}",
year = "2019",
month = "8",
day = "1",
doi = "10.1016/j.amsu.2019.06.014",
language = "English",
volume = "44",
pages = "72--76",
journal = "Annals of Medicine and Surgery",
issn = "2049-0801",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - Staple-line leak post primary sleeve gastrectomy. A two patient case series and literature review

AU - Loo, Guo Hou

AU - Rajan, R.

AU - Nik Mahmood, Nik Ritza Kosai

PY - 2019/8/1

Y1 - 2019/8/1

N2 - There is an increasing trend in the number of bariatric surgeries performed worldwide, partly because bariatric surgery is the most effective treatment for morbid obesity. Sleeve gastrectomy (SG) remains the most common bariatric surgery procedure performed, representing more than 50% of all primary bariatric interventions. Major surgical complications of SG include staple-line bleeding, leaking, and stenosis. A leak along the staple-line most commonly occurs at the gastroesophageal junction (GOJ). From January 2018 to December 2018, our centre performed 226 bariatric procedures, of which, 97.8% were primary bariatric procedures. The mean age and BMI were 38.7±8.3 years and 44 kg/m2, respectively. Out of the 202 primary SG performed, we encountered two cases of a staple-line leak (0.99%). This is the first reported case series of SG leaks from the Southeast Asia region. A summary of their characteristics, clinical presentation, subsequent management, and the outcome is discussed. Based on the latest available evidence from the literature, several methods may decrease staple-line leaks in SG. These include the use of a bougie size greater than 40 Fr, routine use of methylene blue test during surgery, beginning transection at 2–6 cm from the pylorus, mobilising the fundus before transection, and staying away from the GOJ at the last firing. Other methods include the proper alignment of the staple-line, control of staple-line bleeding, and performing staple-line reinforcement. The management of a staple-line leak remains challenging due to limited systematic, evidence-based literature being available. Therefore, a tailored approach is needed to manage this complication.

AB - There is an increasing trend in the number of bariatric surgeries performed worldwide, partly because bariatric surgery is the most effective treatment for morbid obesity. Sleeve gastrectomy (SG) remains the most common bariatric surgery procedure performed, representing more than 50% of all primary bariatric interventions. Major surgical complications of SG include staple-line bleeding, leaking, and stenosis. A leak along the staple-line most commonly occurs at the gastroesophageal junction (GOJ). From January 2018 to December 2018, our centre performed 226 bariatric procedures, of which, 97.8% were primary bariatric procedures. The mean age and BMI were 38.7±8.3 years and 44 kg/m2, respectively. Out of the 202 primary SG performed, we encountered two cases of a staple-line leak (0.99%). This is the first reported case series of SG leaks from the Southeast Asia region. A summary of their characteristics, clinical presentation, subsequent management, and the outcome is discussed. Based on the latest available evidence from the literature, several methods may decrease staple-line leaks in SG. These include the use of a bougie size greater than 40 Fr, routine use of methylene blue test during surgery, beginning transection at 2–6 cm from the pylorus, mobilising the fundus before transection, and staying away from the GOJ at the last firing. Other methods include the proper alignment of the staple-line, control of staple-line bleeding, and performing staple-line reinforcement. The management of a staple-line leak remains challenging due to limited systematic, evidence-based literature being available. Therefore, a tailored approach is needed to manage this complication.

KW - Asian population

KW - Bariatric surgery

KW - Complications

KW - Endoscopic stenting

KW - Southeast Asia

UR - http://www.scopus.com/inward/record.url?scp=85068364232&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85068364232&partnerID=8YFLogxK

U2 - 10.1016/j.amsu.2019.06.014

DO - 10.1016/j.amsu.2019.06.014

M3 - Article

AN - SCOPUS:85068364232

VL - 44

SP - 72

EP - 76

JO - Annals of Medicine and Surgery

JF - Annals of Medicine and Surgery

SN - 2049-0801

ER -