Management of Gastric Leak after Sleeve Gastrectomy: A 13-year Experience in a Tertiary Referral Center.

Introduction: The main complication of sleeve gastrectomy remains fistula formation. Studies have mainly focused on the endoscopic management of fistulas, and surgery is reserved for cases of hemodynamic instability or treatment failure. The aim of this study was to evaluate the management of gastric leak after sleeve gastrectomy.

Methods: We retrospectively analyzed the characteristics, treatments, and outcomes of patients managed for gastric leaks after sleeve gastrectomy in our center. Healing was defined as resumed oral intake without inflammatory syndrome or the presence of drainage material.

Results: From 2009 to 2022, 43 patients were managed in our center for gastric leak after sleeve gastrectomy. Among them, 21 patients were referred from other centers. In 86% of cases, the gastric leak developed within the first 15 days. It was located at the proximal staple line in 84% of cases. Associated stenosis or twisting was observed in 18% of cases. Surgical treatment alone was used in 32% of patients, while 59% received combined management. Only 3 patients (6.8%) were managed exclusively by endoscopy. The overall healing rate was 91%, with a median healing time of 89 days.

Conclusion: The management of gastric leaks after sleeve gastrectomy depends on their location and clinical presentation and should not be limited to a solely endoscopic or surgical approach. Our study demonstrates that surgical intervention alone may be sufficient in 30% of cases. However, for most patients, a multidisciplinary approach in a referral center is recommended.