Gastric Leak by Staple-Line Rupture after Sleeve Gastrectomy for Morbid Obesity

Special Article – Bariatric Surgery

Ann Surg Perioper Care. 2017; 2(2): 1026.

Gastric Leak by Staple-Line Rupture after Sleeve Gastrectomy for Morbid Obesity

Frattini F*, Lavazza M, Delpini R, Rausei S and Dionigi G

Research Center for Endocrine Surgery, University of Insubria, Varese, Italy

*Corresponding author: Francesco Frattini, Research Centre for Endocrine Surgery, University of Insubria, Varese, Italy

Received: April 05, 2017; Accepted: April 28, 2017; Published: May 05, 2017

Introduction

Gastric leak is the most fearing complication following sleeve gastrectomy. It occurs in 1-3% of cases and involves the proximal third of the gastric tube just below the esophago-gastric junction (EGJ) in most cases [1].

We report a case of gastric leak after sleeve gastrectomy in which endoscopy resulted useful in assessment of the vascularization of the tissue close to the gastric leak.

Case Presentation

A 42-year-old, BMI 42kg/m² female, suffering from arterious hypertension underwent laparoscopic sleeve gastrectomy. Intraoperative indocyanine-green enhanced fluorescence imaging showed proper vascularization of the gastric tube (Figure 1). A barium swallow on second postoperative day showed no leak or stenosis (Figure 2). A gastric fistula at the EGJ appeared 5 days after surgery. The patient presented fever, abdominal pain, dispnea, leukocytosis and high values of CRP. A thoraco-abdominal computed tomography (CT) scan with oral contrast detected a gastric leak just below the EGJ supplying a left sub diaphragmatic collection extended all over the spleen (Figure 3 and 4).