# Management of Leakage After Sleeve Gastrectomy: Outcome, Treatment Algorithm, and Predictors of Resolution

## TL;DR

This study examines the occurrence and management of leakage after sleeve gastrectomy, identifying risk factors and a treatment algorithm with a high resolution rate.

## Contribution

The study introduces a treatment algorithm for post-sleeve gastrectomy leakage and identifies predictors of leakage occurrence and resolution.

## Key findings

- Leakage occurred in 1.09% of 1289 patients undergoing sleeve gastrectomy.
- Smoking and diabetes mellitus were significant predictors of leakage occurrence.
- Higher BMI was significantly associated with non-resolution of leakage after initial treatment.

## Abstract

Background

Laparoscopic sleeve gastrectomy (LSG), which is increasing in popularity, is associated with certain complications. One of the most dreaded complications following LSG is a leakage from the staple line. Therefore, it is mandatory for surgeons to be alert to the risk factors of leakage and to be familiar with the leakage treatment choices. The aim of this study is to assess the post-LSG leakage rate, predictors of leakage, and present the treatment algorithm and its outcomes.

Methods

This retrospective cohort study included patients who underwent LSG at our institution during the period from 2018 to 2023. The diagnosis and management algorithm of leakage, as well as the outcomes of treatment, were assessed.

Results

Out of the included 1289 patients, leakage occurred in 14 patients (1.09%). All patients with leakage primarily received supporting treatment. Finally, the leak resolution rate was 92.86% (13/14). Leakage-management complications occurred in four patients (28.57%), all of whom required ICU admission. Regression analysis showed that higher BMI was the only significant predictor of non-resolution after initial treatment (p<0.001), while smoking (p = 0.002) and diabetes mellitus (p = 0.009) were the predictors of leakage occurrence.

Conclusion

The treatment algorithm used in the current study proved effective in managing post-LSG leakage, despite the occurrence of some complications. Computed tomography (CT) and endoscopy demonstrated a complementary diagnostic role in accurately identifying leaks. Smoking and diabetes mellitus were identified as predictors of leakage occurrence, while higher BMI was significantly associated with non-resolution of leakage after initial treatment.