The evolution of surgical treatment for chronic leak following sleeve

Abstract Introduction Leak is estimated to be the most severe complication of laparoscopic sleeve gastrectomy (LSG), with sporadic failure of endoscopic techniques. In such case, an aggressive management with surgical reconstructive procedures can be proposed in patients in whom all the conservative endoscopic techniques failed. Objectives The purpose of the present study was to report our experience with surgical approach for the treatment of chronic leak after LSG. Setting University hospital, France Methods Between January 2013 - December 2019, 21 consecutive patients underwent reconstructive surgery for the treatment of chronic leak after LSG. The initial intervention, the endoscopic approach and the definitive surgical repair were carefully reviewed. Results Twenty-one patients (17 women) with a mean (SD) age of 42.7 years (9.81) and a mean (SD) body mass index (BMI) of 27.3 (5.2) kg/m2 underwent reconstructive surgery for persistent fistula. Seventeen patients (81%) had their early LSG performed in another hospital. Endoscopic treatment was represented by the: pigtail drain or stent in 9 cases each, ovesco in 8 cases, and glue for 2 patients. The reconstructive surgery was performed within 6 months - 8 cases; between 6 and 12 months in 6 cases; between 1 and 3 years in 4 cases and after 3 years in 3 cases. There were 14 fistulo-jejunostomy (66.7 %), 5 Roux-en-Y gastric bypass (23.8 %) and 2 total gastrectomies (9.5 %). The operative time was between 99 minutes and 5 and a half hours (mean = 216.2, median=225 minutes). The hospital stay ranged from 5 to 30 days (mean = 12.67, median=11 days) and the surgical reintervention rate was 23.8% (5/21 patients), including one case of recurrent haemorrhage requiring 3 surgical operations over one month of post-operative follow-up. No post-operative mortality was recorded. Conclusions Surgery should be considered in case of failure of the endoscopic treatment of chronic leak after LSG. Further research is needed to clearly identify the appropriate treatment, but in our experience the fistulo-jejunostomy approach is offering a low morbidity rate.