Background

Sleeve gastrectomies as a surgical approach to weight loss have become increasingly common, however, they are not without complications with gastric leaks occurring between 1-3% of total cases. Patient's are increasingly having the procedure done internationally with 2% of bariatric procedures being performed as medical tourism. In this report we present a gastric leak after a sleeve gastrectomy abroad that was treated with an endoluminal wound vac followed by gastric stenting.

Methods

Patient is a 52 y/o female with a past medical history of hypertension and obesity status post laparoscopic sleeve gastrectomy abroad eight days prior who presented with abdominal pain and concerning signs of sepsis. Imaging consistent with gastric leak. She underwent a robotic assisted diagnostic laparoscopy with washout, repair of the perforation with omental patch and subsequent drain placement. Patient was then re-admitted due to concern of persistent leak. Upper endoscopy (EGD) revealed fistulization of the drains through the site of perforation requiring 3 sessions of endoluminal wound vac. The final EGD showed viable, healthy tissue which was subsequently covered with two interposing covered gastric stents.

Conclusions

Gastric leaks following sleeve gastrectomy can be divided into type 1 (subclinical) and type 2 (clinical), as this patient developed signs of sepsis as well as a non contained fistula tract she is categorized as a late type 2 leak. Intraluminal wound vac is a safe and effective therapy option to manage complicated gastric leaks as second line therapy.