Laparoscopic Associates of San Francisco
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FAQ: Information on leak tests

May 15th, 2009 Posted in Duodenal switch, Vertical gastrectomy, Vertical sleeve gastrectomy, weight loss surgery

We have performed the vertical sleeve gastrectomy (vertical gastrectomy) in 1,300 patients and the duodenal switch in 900 patients, thus we have performed the sleeve gastrectomy procedure in over 2,000 patients since 1999.  In November of 2006, after completing over 600 vertical sleeve gastrectomies, we stopped doing the intra-operative leak test for three reasons.  Inflation of the stomach immediately after stapling it often stressed the staple line and caused additional bleeding.  The leak test was never positive in the operating room, yet 0.3% of the patients developed a leak from 5 to 35 days postoperative.  We still offer an early or late upper GI x-ray to our patients who wish to have it done, but we do not do it routinely, since even these studies have been negative in the first week and a leak developed late.  Since a leak can develop at any time in the first month, a single leak test in the first few days after weight loss surgery is no guarantee that a leak won’t happen.  We ask all our patients to call us immediately if they develop fevers, sweats, rapid heart rate and/or increasing abdominal pain.  We have also found that good surgical technique with a maximally reinforced stapler and a liquid diet for two weeks has kept our leak rate close to zero.

 

Paul Cirangle, MD

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