Comment on: Laparoscopic Roux-en-Y fistulojejunostomy as a salvage procedure in patients with chronic gastric leak after sleeve gastrectomy.

With the growing incidence of morbid obesity worldwide and laparoscopic sleeve gastrectomy as the most common bariatric procedure performed worldwide for a decade now, it is estimated that well over 1 million sleeves have been performed since its inception [ [1] Clapp B. Ponce J. DeMaria E. et al. American Society for Metabolic and Bariatric Surgery 2020 estimate of metabolic and bariatric procedures performed in the United States. Surg Obes Relat Dis. 2022; 18: 1134-1140 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar ]. Despite sleeve leak rates having decreased nearly 10-fold to a low prevalence of .1%, they remain the most common, serious, and challenging complication and translate to more than 1000 leaks that have been managed [ [2] Nedelcu M. Danan M. Noel P. Gagner M. Nedelcu A. Carandina S. Surgical management for chronic leak following sleeve gastrectomy: review of literature. Surg Obes Relat Dis. 2019; 15: 1844-1849 Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar ]. First-line management has included endoscopic techniques such as stenting, drainage, and clipping, or a combination thereof [ [3] Nedelcu M. Manos T. Cotirlet A. Noel P. Gagner M. Outcome of leaks after sleeve gastrectomy based on a new algorithm addressing leak size and gastric stenosis. Obes Surg. 2015; 25: 559-563 Crossref PubMed Scopus (81) Google Scholar ]. For those that fail endoscopic interventions, described surgical techniques include Roux-en-Y gastric bypass (RYGB), fistula-jejunostomy, and esophagojejunostomy (EJ) with leak rates of 38%, 22%, and 8%, respectively. High leak rates as a consequence of treating a leak are particularly disheartening and beg the question of whether a better approach can be found. Laparoscopic Roux-en-Y fistulojejunostomy as a salvage procedure in patients with chronic gastric leak after sleeve gastrectomySurgery for Obesity and Related DiseasesVol. 19Issue 6PreviewThe most common postoperative complication of laparoscopic sleeve gastrectomy (LSG) is staple-line leak. Even if its rate following LSG has been recently reduced, management of chronic leaks remains challenging. Full-Text PDF