Background

Late gastric leaks after sleeve gastrectomy present a unique challenge. They occur during the period of healing and inflammation that makes operative interventions not only difficult but also dangerous. . A 49-year-old female, 5 weeks status-post laparoscopic sleeve gastrectomy, had been recovering well and tolerating her diet. She presented with four days of acute epigastric abdominal pain accompanied by nausea and high fevers. Upper GI study revealed contrast extravasation consistent with a gastric leak. A hostile abdomen was encountered on laparoscopy, prompting drain placement for the abscess, and closure. Endoscopy shortly thereafter confirmed a leak immediately distal to the GE junction. A Boston Scientific 153 mm covered esophageal stent was placed. The stent was exchanged during repeat endoscopy after 2 weeks, and repeated twice for a total of 3 stents over a period of 8 weeks. A repeat upper GI series demonstrated no further contrast extravasation. . The use of stents has been described for management of post-op leaks, however there is a wide variation in several key areas; including early vs intermediate vs late leaks, full vs partial covered stents, duration of individual stent placement, and duration of overall treatment. Non-operative management with drains and stents for late leaks after sleeve gastrectomy is safe and effective, and may often obviate the need for revision surgery and its associated morbidity/mortality. After ensuring stability and initial response to treatment, select patients may continue their course as outpatients. Further prospective data is needed to determine standards for timing and duration of treatment.