Complications of Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy (LSG) is an increasingly used bariatric surgical procedure that consists of removing a large part of the stomach.

Significant advantages include the ease of performing the procedure (this used to be the “easy” first-step of a two-stage Roux-N-Y bypass in severely compromised patients), preservation of the pylorus, and maintenance of physiological food passage.

However, like all surgical procedures, it has its risks.

This prompted the recent report by Frezza and colleagues from the University of Alabama, Birmingham, Al, who examined the complication rates of LSG in their own case series and in 17 published articles from other centres (OBESITY SURGERY).

In their own case series of 53 patients who underwent LSG, no patients died but five (9.4%) developed complications which included two staple line leaks that required reoperations, one preceded by vomiting, the other by coughing as well as three staple line hemorrhages, one requiring hospitalization.

In the published articles, the median complication was 4.5%, with 3.6% of procedures requiring reoperation.

Thus, although the risk of death appears low, around 1 in 20 cases may require reoperation due to a perioperative complication.

Although this may sound a lot, it is important to remember that patients undergoing this operation are generally quite large (average BMI 51 in this case series) and quite sick (average of 8 co-morbidiites in this case series).

The authors calculate that it would actually require a study of more than 3,000 procedures to detect halving the odds of reoperation.

Because leaks and reoperation in this series were preceded by large increments in intraabdominal pressure, the authors propose that more attention to staple line reinforcements that increase burst pressure may be warranted.

Also, perioperative management to avoid vomiting and coughing may be helpful.

As bariatric surgery continues to evolve as by far the most effective treatment for severe obesity, everyone involved in the care of these patients must realize that surgical treatment of obesity will never be without risks.

Edmonton, Alberta