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Leak after gastric sleeve surgery is one of the issues that patients are concerned about in bariatric surgery. As known, gastric sleeve surgery has been performed since the 1990s. However, it took its final form in the early 2000s. With this surgery, many patients suffering from obesity have reached their ideal weight and now lead a healthier life.
The issue of leakage creates great anxiety in patients. However, it can be said that the risk of leakage in gastric sleeve surgery is only around 2% to 3%. We will discuss the symptoms of this problem and in which patients it is more common. But first, let’s examine the subject in more detail.
What Is Leak After Gastric Sleeve Surgery?
In its simplest definition, leak after gastric sleeve surgery is the leakage from the stomach that has been sutured or stapled during surgery. The procedure in gastric sleeve surgery involves cutting and suturing the stomach from the lower end to the top. Leakage occurs when this process is not performed properly, causing food and stomach acid to leak outside the stomach.
Under normal conditions, the food we eat passes through a tube system starting from the mouth, going through the stomach, duodenum, small intestine, large intestine, and finally exiting through the rectum. If there is a hole anywhere in this system, the food leaks out and causes infection in the abdominal cavity. For example, it is similar to a ruptured appendix.
When the appendix ruptures, the food we eat leaks into the abdomen, and if this infection is not noticed, it can result in death. The only treatment is removing the inflamed appendix and closing the hole in the intestine. The same applies to leak after gastric sleeve surgery. When food and stomach acid leak into the abdomen, infection occurs, and if not detected, it is even more dangerous than appendicitis because stomach acid is much more harmful.
Symptoms of Leak After Gastric Sleeve Surgery
Patients sometimes wonder whether leak after gastric sleeve surgery can be detected and what symptoms occur. It is almost impossible for patients to detect leakage in the early period because they often attribute symptoms to the surgery itself. The most important factor in detecting leakage within the first 12 hours is the experience of the nurse on duty.
In such surgeries, the doctor is not always present in the hospital, and all information is communicated by nurses. The first sign of leakage is an increase in pulse rate. If the pulse increases despite adequate fluid intake and serum support, it is a sign of leakage. Patients are mobilized within 4-6 hours after surgery. If the patient feels extremely tired and has difficulty walking, this is the second sign.
Fever usually appears as a late finding on the first day and does not decrease. Despite antibiotics, the fever persists. By the end of the first day, leaked fluids affect the abdominal membrane and infection begins, causing abdominal pain. All these symptoms are also reflected in blood values. As a team, we check blood values at the 6th and 12th hours after surgery. If leakage is detected on the first day, it can be prevented with simple intervention.
How Is Leak Treated After Gastric Sleeve Surgery?
First of all, if leak after gastric sleeve surgery is detected, it can be treated and deaths do not occur. The biggest problem is discharging the patient with leakage and not following up. Delayed leaks can result in death, similar to a delayed ruptured appendix.
When leakage is detected, the first step is to stop oral intake. The location of the leak can be determined by endoscopy and tomography. It is also necessary to detect whether there is an infection in the abdomen. If there is infection, it must be drained radiologically.
Draining the infection alone treats half of the leaks. Then, to close the hole in the stomach, a special drain or a stent can be placed. After confirming that there is no leakage, the patient can be discharged. These apply to early-detected leaks. If detected after discharge, the process becomes much more difficult.
Why Does Leak Risk Occur?
Doctor
The cause of leak after gastric sleeve surgery is 99% related to the surgeon. If there is any condition that prevents surgery, it is canceled. This surgery is not an emergency procedure.
Surgical experience develops after performing around 200 gastric sleeve surgeries. As experience increases, the risk of leakage decreases.
Surgical Errors
Surgical errors due to lack of experience are the main cause. If the stomach is not cut properly, narrowing occurs, leading to vomiting. If untreated, the stomach may rupture.
Materials Used in Surgery
One of the most important factors is the quality of materials used. Some materials do not have FDA or CE approval. Low-quality materials increase the risk of leakage.
Single-use materials must not be reused. Otherwise, infection and leakage risk increase.
Who Is at Higher Risk?
Leak risk is not related to individuals. Since endoscopy is performed before surgery, patients with stomach disease are not operated on. Therefore, the risk is the same for everyone.
How Is Leak Test Performed?
Tests to prevent leak after gastric sleeve surgery start during the operation.
- The abdomen is filled with fluid and air is given orally. If there is a leak, it becomes visible.
- Methylene blue test is applied. If blue fluid appears, there is leakage.
During hospitalization:
- CRP levels are monitored
- Blue dye test is repeated
- Radiological evaluation is performed
After discharge, blood tests are performed within the first week.
In total, 6 tests are performed. Leaks usually appear on days 1, 3, 5, and 7. Late leaks are extremely rare.
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