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Gastric leak after sleeve gastrectomy: risk factors for poor evolution under conservative management
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International audience. Background: Gastric leak (GL) is the most highly feared early postoperative complication after sleeve gastrectomy (SG), with an incidence of 1% to 2%. This complication may require further surgery/endoscopy, with a risk of management failure that may require additional surgery, including total gastrectomy, leading to a risk of mortality of 0% to 9%. Objectives: Assess the impact of factors that may lead to a poorer evolution of GL. Setting: University Hospital, France, public practice. Methods: This was a retrospective, single-center study of a group of patients managed for GL after SG between November 2004 and January 2019 (n = 166). Forty-three patients were excluded. The population study was divided into 2 groups: patients with easy closing of the GL (n = 73) and patients with difficult closing of the GL or failure to heal (n = 50). Patients were allocated to 1 of 2 groups depending on the time to heal (median time of 84 days). The study's primary efficacy endpoint was to determine the risk factors for a poorer evolution of GL. Results: Among 123 patients included in this study, 103 patients had undergone primary SG (83.7%). The mean time to the appearance of GL was 15.1 days (range, 1-156 d). Seventy-four patients underwent a reoperation (60%). The mean number of endoscopies per patient was 2.7 (range, 2-7 endoscopies). The mean time to healingwas 89.5 days (range, 18-386 d). There were 8 cases of healing failure (6.5%). Multi-variate analysis identified body mass index (>47 kg/m(2)), time to referral (>2 d), and serum prealbumin level (<.1 g/dL) to be independent risk factors for a poorer evolution of GL. Conclusion: Improvement of nutritional status before SG and early referral for GL could reduce the risk of delayed closure or the need for further surgery. (C) 2021 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
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