Several factors influence staple line leakage after sleeve gastrectomy

Last Updated: 2016-01-15

By Will Boggs MD

NEW YORK (Reuters Health) - Intraoperative complications, operation time, and other factors influence the rate of staple line leakage after sleeve gastrectomy for obesity, researchers from Germany report.

"Always you have to perform/use staple line buttresses or oversew the whole staple line," Dr. Christine Stroh from SRH Municipal Hospital Gera, told Reuters Health by email.

Staple line leakage is the most frequent and most feared complication of laparoscopic sleeve gastrectomy, an emerging method of bariatric surgery.

Dr. Stroh and colleagues in the Obesity Surgery Working Group, Competence Network Obesity used data from 11,840 patients in the German Bariatric Surgery Registry (GBSR) to analyze factors that increase the leakage rate after sleeve gastrectomy (98.2% of which were completed by laparoscopy).

The leakage rate was lowest for the procedures completed with laparoscopy (1.39%), intermediate in those with primary laparotomy (3.60%), and highest for procedures with conversion to open approach (12.12%, p<0.001), according to the December 31 Annals of Surgery online report.

The most important factors increasing the leakage rate were the presence of intraoperative complications and an earlier operation year, a reflection of the learning curve (both p<0.001).

Other factors associated with significantly higher leakage rates included intraoperative leakage testing, longer operation time, younger patient age, and the use of reinforcement and oversewing versus a pure staple line.

"The key factors for a patient's outcome in the case of a leak are early detection and adequate management," the researchers note. "Early reintervention is associated with better results and a lower general complication and mortality rate."

"These findings may help surgeons to define risk groups and to carefully select patients," they conclude. "Moreover, it would permit more differentiated patient counseling before surgery and closer follow-up during the postoperative course of patients at risk."

Dr. Michel Gagner from Hopital du Sacre Coeur, Montreal, Quebec, Canada, recently reported on the impact of the surgical experience on leak rate after laparoscopic sleeve gastrectomy. He told Reuters Health the "constant decrease in leak rates (the most dreadful complication of this operation, and difficult to treat) . . . is an excellent surprise, as most previous papers presented a constant 2-2.5% leak rate, now it is going toward <1%, making it very acceptable and perhaps it will continue to decline to almost nil. This is a similar progression to when laparoscopic gastric bypass was introduced."

"It also confirms that buttress with oversewing is causing more leaks, and this is to be avoided," he said by email.

"As we have a worldwide epidemic of more than 350 million severely obese patients, this operation fulfills the criteria now of: 1) a rapid procedure, with 2) the least amount of morbidity and mortality," Dr. Gagner concluded.

"We need to do more to have a noticeable impact on this disease . . . yet we do about 0.5% of all potential cases of severe obesity. To have an impact, we should be doing 5 million operations a year, not 500,000 per year," Dr. Gagner added.

Johnson & Johnson MEDICAL GmbH, Ethicon Endo-Surgery Deutschland, Norderstedt. Covidien Deutschland GmbH, Neustadt/Donau support GBSR. The authors reported no disclosures.

SOURCE: http://bit.ly/1P4lzvH

Ann Surg 2015.