Management and outcomes of gastric leak after sleeve gastrectomy: results from the 2010-2020 national registry.

Mengyi LI; Na Zeng; Yang Liu; Xitai Sun; Wah Yang; Yanjun Liu; Zhongqi Mao; Qiyuan Yao; Xiangwen Zhao; Hui Liang; Wenhui Lou; Chiye MA; Jinghai Song; Jianlin WU; Wei Yang; Pin Zhang; Liyong Zhu; Peirong Tian; Peng Zhang; Zhongtao Zhang

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Management and outcomes of gastric leak after sleeve gastrectomy: results from the 2010-2020 national registry.

Author: Mengyi LI ¹ ; Na ZENG ² ; Yang LIU ¹ ; Xitai SUN ³ ; Wah YANG ⁴ ; Yanjun LIU ⁵ ; Zhongqi MAO ⁶ ; Qiyuan YAO ⁷ ; Xiangwen ZHAO ⁸ ; Hui LIANG ⁹ ; Wenhui LOU ¹⁰ ; Chiye MA ¹¹ ; Jinghai SONG ¹² ; Jianlin WU ¹³ ; Wei YANG ¹⁴ ; Pin ZHANG ¹⁵ ; Liyong ZHU ¹⁶ ; Peirong TIAN ¹ ; Peng ZHANG ¹ ; Zhongtao ZHANG ¹
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1. Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & National Clinical Research Center for Digestive Diseases, Beijing 100050, China.
2. School of Public Health, Peking University, Beijing 100191, China.
3. Department of General Surgery, Nanjing Drum Tower Hospital, Nanjing, Jiangsu 210008, China.
4. Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, China.
5. Center of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, The Third People's Hospital of Chengdu & The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan 610014, China.
6. Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China.
7. Center for Obesity and Metabolic Surgery, Huashan Hospital, Fudan University, Shanghai 200030, China.
8. Department of Metabolic and Bariatric Surgery, Xiaolan People's Hospital of Zhongshan, Zhongshan, Guangdong 528415, China.
9. Department of General Surgery, First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 226399, China.
10. Department of General Surgery, Zhongshan Hospital, Shanghai 200032, China.
11. Department of Gastrointestinal Surgery, Dongfang Hospital of Shaghai, Shanghai 200120, China.
12. Department of General Surgery, Beijng Hospital, Beijing 100730, China.
13. Department of Gastrointestinal Surgery, Zibo Central Hospital, Zibo, Shandong 255020, China.
14. Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China.
15. Department of Bariatric and Metabolic Surgery, Shanghai Jiao Tong University affiliated Sixth People's Hospital, Shanghai 200233, China.
16. Department of Gastrointestinal Surgery,The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, China.
Collective Name:Greater China Metabolic and Bariatric Surgery Database (GC-MBD) study group
Publication Type:Journal Article
MeSH: Humans; Male; Retrospective Studies; Diabetes Mellitus, Type 2/complications*; Obesity, Morbid; Anastomotic Leak/epidemiology*; Gastrectomy/methods*; Reoperation/methods*; Registries; Laparoscopy/methods*; Treatment Outcome
From: Chinese Medical Journal 2023;136(16):1967-1976
CountryChina
Language:English
Abstract: BACKGROUND:Management of gastric leak after sleeve gastrectomy (SG) is challenging due to its unpredictable outcomes. We aimed to summarize the characteristics of SG leaks and analyze interventions and corresponding outcomes in a real-world setting.
METHODS:To retrospectively review of 15,721 SG procedures from 2010 to 2020 based on a national registry. A cumulative sum analysis was used to identify a fitting curve of gastric leak rate. The Kaplan-Meier method and log-rank tests were performed to calculate and compare the probabilities of relevant outcomes. The logistic regression analysis was conducted to determine the predictors of acute leaks.
RESULTS:A total of 78 cases of SG leaks were collected with an incidence of 0.5% (78/15,721) from this registry (6 patients who had the primary SG in non-participating centers). After accumulating 260 cases in a bariatric surgery center, the leak rate decreased to a stably low value of under 1.17%. The significant differences presented in sex, waist circumference, and the proportion of hypoproteinemia and type 2 diabetes at baseline between patients with SG leak and the whole registry population ( P = 0.005, = 0.026, <0.001, and = 0.001, respectively). Moreover, 83.1% (59/71) of the leakage was near the esophagogastric junction region. Leakage healed in 64 (88.9%, 64/72) patients. The median healing time of acute and non-acute leaks was 5.93 months and 8.12 months, respectively. Acute leak (38/72, 52.8%) was the predominant type with a cumulative reoperation rate >50%, whereas the cumulative healing probability in the patients who required surgical treatment was significantly lower than those requring non-surgical treatment ( P = 0.013). Precise dissection in the His angle area was independently associated with a lower acute leak rate, whereas preservation ≥2 cm distance from the His angle area was an independent risk factor.
CONCLUSIONS:Male sex, elevated waist circumference, hypoproteinaemia, and type 2 diabetes are risk factors of gastric leaks after SG. Optimizing surgical techniques, including precise dissection of His angle area and preservation of smaller gastric fundus, should be suggested to prevent acute leaks.