Abstract:
Background: Laparoscopic gastric sleeve (LGS) is a safe bariatric procedure, growing in popularity due to its technical simplicity and good weight loss outcomes. Bleeds and staple line leak are the most common complications. The postoperative staple line leak does not adversely impact the weight loss and resolution of comorbidities. However, this complication can result in prolonged hospitalization, increased morbidity, sepsis, multi-organ failure and even death. We perform a systematic review to identify patient-factors and surgical strategies that may decrease leak and bleeds after LSG. Results: Causes of leak are classified as mechanical, technical and ischemic causes. Identified patient-related risk factors are high BMI, ASA, hypertension and degenerative joint disease. The possible contribution of NSAIDs requires further investigation. Essential surgical technique recommendations include: use a bougie size = 40 Fr; use appropriate cartridge colors from antrum to fundus; follow a proper staple line, with a wide berth around bougie at the incisura angularis; stay away from the angle of His at least 1 cm; check the bleeding from the staple line and avoid 1-stage revisional sleeve concomitant wi...