Publication:

Technical details of laparoscopic sleeve gastrectomy with attention to staple line leak and hemorrhage: discussion of 3,031 consecutive cases

Background Laparoscopic sleeve gastrectomy continues to rise as an effective surgical procedure for weight loss in obese patients. With that, gastric staple line leak and hemorrhage remain the most serious complications and occur in up to 3% of all cases. Each complication is associated with a high degree of morbidity and mortality for the patient as well as substantial cost of care for institutions and payers. Techniques to minimize the risk of sleeve gastrectomy leak and hemorrhage have been published although no universally agreed upon set of techniques exists. This report updates a single-surgeon experience with an approach to sleeve leak and hemorrhage prevention over 10 years.

Methods 3,031 consecutive sleeve gastrectomy cases between 2012 and 2021 were reviewed retrospectively. Patient characteristics, incidence of leaks and hemorrhage, and percent body weight loss at 6 months were reported for each year. Conceptual and technical changes aimed towards leak and hemorrhage reduction are presented.

Results With the implementation of the described techniques of sleeve gastrectomy, the rate of sleeve leaks fell from 3.8% in 2012 to 0% in 2015 through 2021, and hemorrhage fell from 1.3% in 2012 to 0.1% in 2018 through 2021. Weight loss remained consistent, as depicted by 6-month change in body weight and percent excess BMI lost.

Conclusion In this single-surgeon experience, sleeve gastrectomy leak rate fell to 0.0% and staple line hemorrhage rate fell to 0.1% with the implementation of specific technical modifications in the procedure, spanning over 3,031 consecutive cases.