Summarizing the prevention and treatment strategies for gastric leak after laparoscopic sleeve gastrectomy (LSG).

A retrospective analysis of 3 760 patients with obesity who underwent LSG in the First Hospital of Jinan University or transferred from other hospital for revision surgery from January 2012 to December 2022. We conducted a retrospective analysis of the clinical data of these patients, including age, gender, surgical approach, time of gastric leak diagnosis, comorbidities such as diabetes and hypertension, preoperative BMI, main symptoms of postoperative gastric leak, treatment measures taken, and healing time.

Among the 3 760 patients who underwent LSG, 14 cases (0.37%) experienced gastric leaks. Of these, 12 cases were transferred from other hospitals for treatment, with only 2 instances of gastric leakage occurring in SG surgeries performed at our hospital.The median time to diagnose gastric leak was 4.50 days, with 85.7% of leaks occurring above the gastric sleeve. There was no statistically significant difference in healing time between upper and lower gastric leaks (P>0.05). Among the patients who experienced postoperative gastric leak, 1 case (7.1%) underwent conservative + surgical (CS) treatment, 10 cases (71.4%) received endoscopy + surgical (ES) treatment, and 3 cases (21.4%) underwent conservative + endoscopy + surgical (CES) treatment. The median healing time for gastric leaks was 29.5 days. 57.1% of patients required a second or even multiple treatments after initial treatment failure.

Classifying gastric leaks after LSG based on their clinical characteristics can help select the optimal treatment approach. Prevention is key in managing gastric leaks after LSG, and Roux-en-Y gastric bypass surgery (RYGB) is a preferred surgical option for treating severe obesity.