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Background <p>Laparoscopic sleeve gastrectomy (LSG) has become a&#xa0;widely adopted bariatric procedure for morbid obesity and metabolic syndrome. Despite its effectiveness, postoperative complications such as staple-line leakage pose significant risks, with varying management strategies reported in the literature. This systematic review evaluated the latest evidence on the management of LSG-associated leaks, focusing on treatment modalities, success rates, and patient outcomes.</p> Methods <p>The review followed PRISMA guidelines. A&#xa0;literature search was performed using PubMed, Web of Science, and Scopus for studies published between January 2020 and January 2025. Eligible studies included observational cohorts and randomized controlled trials examining different approaches to managing LSG-related leaks. Data extraction included patient demographics, intervention types, leakage timing, success rates, recovery duration, and complications. The Newcastle–Ottawa Scale was used to assess study quality.</p> Results <p>A&#xa0;total of 11&#xa0;studies were included, encompassing a&#xa0;diverse range of treatment strategies. Conservative management was effective for early-stage leaks (&lt; 3&#xa0;days), while intermediate and late-stage leaks often required invasive approaches such as laparoscopic revision, endoscopic stenting, or conversion to gastric bypass. Endoscopic stenting demonstrated high success rates (up to 100% in select studies), although complications such as stent migration (21.42%) and strictures were noted. Reinforcement techniques, including fibrin glue and staple-line reinforcement, reduced reoperation rates (0.7% vs.&#xa0;4.9%) but did not completely eliminate leaks. The median healing time was 5.93–8.12&#xa0;months, depending on leak severity and treatment modality.</p> Conclusion <p>Managing LSG-related leaks requires a&#xa0;tailored approach based on leak timing and severity. Conservative treatments are effective for early leaks, while endoscopic and surgical interventions are necessary for more complex cases. Reinforcement techniques may reduce complication rates but require further validation. Future research should focus on standardized treatment protocols and long-term patient outcomes.</p>

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Updates in the management of leakage resulting from laparoscopic sleeve gastrectomy: a systematic review of the literature

  • 期刊论文

  • 发表日期：

    2025年9月9日

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  • Arief Arrowaili

摘要

Background

Laparoscopic sleeve gastrectomy (LSG) has become a widely adopted bariatric procedure for morbid obesity and metabolic syndrome. Despite its effectiveness, postoperative complications such as staple-line leakage pose significant risks, with varying management strategies reported in the literature. This systematic review evaluated the latest evidence on the management of LSG-associated leaks, focusing on treatment modalities, success rates, and patient outcomes.

Methods

The review followed PRISMA guidelines. A literature search was performed using PubMed, Web of Science, and Scopus for studies published between January 2020 and January 2025. Eligible studies included observational cohorts and randomized controlled trials examining different approaches to managing LSG-related leaks. Data extraction included patient demographics, intervention types, leakage timing, success rates, recovery duration, and complications. The Newcastle–Ottawa Scale was used to assess study quality.

Results

A total of 11 studies were included, encompassing a diverse range of treatment strategies. Conservative management was effective for early-stage leaks (< 3 days), while intermediate and late-stage leaks often required invasive approaches such as laparoscopic revision, endoscopic stenting, or conversion to gastric bypass. Endoscopic stenting demonstrated high success rates (up to 100% in select studies), although complications such as stent migration (21.42%) and strictures were noted. Reinforcement techniques, including fibrin glue and staple-line reinforcement, reduced reoperation rates (0.7% vs. 4.9%) but did not completely eliminate leaks. The median healing time was 5.93–8.12 months, depending on leak severity and treatment modality.

Conclusion

Managing LSG-related leaks requires a tailored approach based on leak timing and severity. Conservative treatments are effective for early leaks, while endoscopic and surgical interventions are necessary for more complex cases. Reinforcement techniques may reduce complication rates but require further validation. Future research should focus on standardized treatment protocols and long-term patient outcomes.