Initial radiologic appearance rather than management strategy predicts the outcomes of sleeve gastrectomy leaks

William Catchlove; Yazmin Johari; Edward Forrest; Amos Au; Kalai Shaw; Peter Nottle; Samantha Ellis; Wendy A Brown; Paul Burton

doi:10.1016/j.soard.2021.11.010

Initial radiologic appearance rather than management strategy predicts the outcomes of sleeve gastrectomy leaks

Surg Obes Relat Dis. 2022 Feb;18(2):205-216. doi: 10.1016/j.soard.2021.11.010. Epub 2021 Nov 13.

Authors

William Catchlove¹, Yazmin Johari², Edward Forrest³, Amos Au³, Kalai Shaw⁴, Peter Nottle³, Samantha Ellis⁵, Wendy A Brown², Paul Burton²

Affiliations

¹ Oesophago-Gastric Bariatric Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Surgery, Monash University, and Centre for Obesity Research and Education, Alfred Hospital, Melbourne, Victoria, Australia. Electronic address: william.catchlove@monash.edu.
² Oesophago-Gastric Bariatric Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Surgery, Monash University, and Centre for Obesity Research and Education, Alfred Hospital, Melbourne, Victoria, Australia.
³ Oesophago-Gastric Bariatric Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia.
⁴ Department of Surgery, Monash University, and Centre for Obesity Research and Education, Alfred Hospital, Melbourne, Victoria, Australia.
⁵ Department of Radiology, The Alfred Hospital, Melbourne, Victoria, Australia.

PMID: 34952796
DOI: 10.1016/j.soard.2021.11.010

Abstract

Background: Initial radiologic appearance rather than management strategy predicts the outcomes of sleeve gastrectomy leaks.

Objective: Multiple modalities have been advocated for the treatment of sleeve gastrectomy leak, and there remains no consensus on the best treatment paradigm. For more than 10 years, we have variably attempted luminal occlusive therapies and repeated endoscopic debridement as treatment options. By evaluating the outcomes from these approaches, we aimed to determine whether the first management strategy is superior to the second in terms of outcomes.

Methods: Patients were analyzed by group (luminal occlusive therapy versus repeated endoscopic debridement). Leaks were then stratified by radiologic appearance on computed tomography, defined as phlegmon, collection, contrast medium leak, or fistula. The primary outcome was length of stay (LOS). Secondary outcomes were comprehensive complication index and the need for resection.

Results: There were 54 patients, with 22 in the luminal occlusion group and 32 in the repeated debridement group. There was no difference in LOS (59.8 ± 41.6 versus 46.5 ± 51.2 days, P = .179) and no difference in the requirement for resection (4 versus 3 resections, p = .425). Subset analysis suggested that patients who underwent operative versus conservative management (P = .006) had a longer LOS. Excluding management strategy, radiologic appearance on admission significantly predicted LOS (P = .0053). Patients presenting with fistula (84 ± 25.4 days) and contrast medium leak (64.1 ± 40 days) had a significantly longer LOS than those diagnosed with phlegmon (13.5 ± 5.5 days). Radiologic appearance was predictive of complication severity (P < .0001) and salvage resection (P = .008).

Conclusion: There was no significant difference in outcomes between patients treated with intraluminal occlusion or repeated debridement. Initial radiologic appearance was predictive of LOS and complication severity. This highlights the need for routine use of a validated classification system in studies reporting outcomes and treatment of sleeve leaks.

Keywords: Bariatric; Classification; Endovac; Leak; Obesity; Sleeve gastrectomy; Surgical complication.

MeSH terms

Anastomotic Leak / diagnostic imaging
Anastomotic Leak / etiology
Anastomotic Leak / surgery
Gastrectomy / adverse effects
Gastrectomy / methods
Humans
Laparoscopy* / methods
Obesity, Morbid* / complications
Reoperation / methods
Retrospective Studies
Treatment Outcome