Management of Staple Line Leaks Following Sleeve Gastrectomy-a Systematic Review

BACKGROUND: A staple line leak following a sleeve gastrectomy is associated with significant morbidity and mortality. No uniform guideline or consensus exists with regard to the optimal treatment approach to managing a staple line leak. OBJECTIVES: The objective of this systematic review is to assess the efficacy and success rates of the different treatment strategies for staple line leak following sleeve gastrectomy. METHODS: A thorough search through four online electronic databases was conducted using predefined search criteria. Our primary outcome measure was to review the treatment options described in the management of the staple line leak following laparoscopic sleeve gastrectomy. Successful initial management was defined as the proportion of cases that were successfully treated using the first modality described, with no escalation to another treatment option. RESULTS: A total of 26 articles were included in this systematic review. Successful initial management of 62% was achieved in patients who underwent endoscopic management, 76% in those who underwent surgery and 82% in patients treated conservatively. A total of 7 patient deaths were noted, all of which were patients who underwent surgery as the initial management of their staple line leak. CONCLUSION: Prompt identification and adequate source control are crucial to successfully manage a staple line leak following sleeve gastrectomy. Treatment options are influenced by the clinical status of the patient. A stepwise treatment escalation approach is required to improve outcomes.