TY - JOUR 
A1 - Ortega Vázquez, Irene
T1 - Prophylactic measures to reduce staple line leaks and bleeding
Y1 - 2018
UR - http://hdl.handle.net/11268/8777
AB - 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 with band removal in high risk patients. Controversy exits regarding efficacy of staple line reinforcement, surgeons should selectively use those tools until this matter is clarified. Routine intraoperative methylene blue test is not effective in preventing or predicting postoperative staple line leak. Conclusions: Laparoscopic gastric sleeve can be performed with low postoperative morbidity and mortality. Standardization of the technique can contribute to decrease postoperative leak rate.
KW - Cirugía
KW - Tecnología médica
KW - Cirugía
KW - Tecnología médica
LA - eng
ER -