[Treatment and prevention of suture failure and bleeding after various bariatric interventions].

Objective: To assess the incidence, treatment and prevention of leakage, as well as bleeding after various types of bariatric interventions.

Material and methods: There were 3.107 various bariatric interventions between 2020 and 2024 including 1.403 (45.2%) laparoscopic sleeve gastrectomies (LSG), 1.622 (52.2%) laparoscopic mini/one anastomosis gastric bypass procedures (MGB-OAGB) and 82 (2.6%) laparoscopic Roux-en-Y gastric bypass surgeries (RYGB). The incidence of intraperitoneal and intraluminal bleeding, suture failure and incidence of complications depending on intraoperative prevention were evaluated. Efficacy of endoscopic VAC system (vacuum-assisted closure) for suture failure after LSG, MGB-OAGB and RYGB was evaluated.

Results: The overall complication rate between 2020 and 2024 was 1.64% (51 patients), suture failure - 0.45% (14 patients), bleeding - 0.71% (22) cases. Ten (71.4%) patients with suture failure were treated using VAC system. In 9 patients, the defect recovered without external gastric fistula. In 5 patients, defect closure was primary, in 4 patients - secondary, i.e. through ulcerative defect. In 1 patient after LSG, the defect did not heal despite VAC therapy for 21 days, and external gastric fistula occurred. Double treatment of stapler line for prevention of postoperative bleeding and leakage reduced the incidence of leaks by 2.5 times, intra-abdominal bleeding by 23 times, intraluminal bleeding from 0.95% to 0%.

Conclusion: Endoscopic VAC system is effective for suture failure after bariatric interventions. Double treatment of stapler suture line can significantly reduce the incidence of bleeding and leakage after LSG, MGB-OAGB and RYGB.