Managing a Gastric Sleeve Leak

Opting to undergo Weight Loss Surgery is a major decision that requires a significant commitment to lifelong lifestyle changes. While bariatric procedures like Gastric Sleeve Surgery are considered relatively low risk, complications can sometimes occur. One potential complication is a gastric sleeve leak.

A gastric sleeve leak involves a small hole or tears in the newly constructed stomach pouch, allowing acidic digestive fluids to escape into the abdominal cavity. Though uncommon, a leak can become a serious medical emergency requiring prompt treatment. As such, bariatric patients need to understand the signs and symptoms of a potential leak and seek immediate medical care if any are present.

What Causes a Gastric Sleeve Leak?

There are a few potential causes for leaks after Gastric Sleeve Surgery:

•    Technical errors during surgery, such as improperly placed surgical staples
•    Weakened stomach tissue, often due to poor blood supply
•    Increased pressure on the new stomach pouch from vomiting, coughing or physical strain

Leaks most often occur within the first few weeks after surgery but can rarely happen months or even years later. Multiple health conditions, nutritional deficiencies, or complications during surgery may increase the risk. However, sometimes leaks occur spontaneously without an identifiable cause.

Recognizing the Signs of a Leak

The symptoms of a gastric sleeve leak can vary but may include:

•    Severe or worsening abdominal pain
•     Fever over 100°F
•     Rapid heart rate
•     Shortness of breath
•     Dizziness or feeling faint
•     Shoulder pain
•     Rash or swelling under the breastbone

Some patients experience mild symptoms or none at all. Since early treatment is critical, promptly contact your bariatric surgeon if you notice any concerning signs or don’t feel well. They will evaluate your symptoms and order tests if a leak is suspected.

Diagnosing a Gastric Sleeve Leak

To check for a potential leak, your surgeon may first obtain blood tests for signs of infection, such as a high white blood cell count. Imaging tests like CT scans or abdominal X-rays can also help identify fluid collections or air pockets resulting from a leak.

Other diagnostic tests include:

• Upper GI series - You swallow a special contrast dye, and X-rays are taken as it travels through your digestive system. Leaks will show up as dye outside the stomach.
•     Endoscopy - A flexible tube with a camera is inserted through your mouth to visualize the stomach for holes directly.
•     Drainage fluid analysis - Fluid is extracted using a needle and tested for gastric contents.
•     Methylene blue test - You drink a blue liquid that will turn your urine green if the stomach leaks.

Getting prompt medical attention and accurate testing is crucial for quick leak detection and treatment.

Treating a Gastric Sleeve Leak

If a leak is confirmed, treatment will depend on its severity, symptoms, and overall health status. Possible treatment options include:

•     IV fluids and infection-fighting medications - You may need to be hospitalized for IV antibiotic and antifungal medications, nutrition, and close monitoring.
•     Drainage and stenting - Doctors may place stents or drains near the leak using endoscopic or radiologic procedures to redirect fluid and allow healing.
•     Second surgery - For larger leaks, surgeons may need to repair, reinforce or even redo the gastric sleeve procedure once the area has had time to heal.
•     Strict dietary changes - You will only be allowed clear liquids until the leak seals, which can take several weeks. Nutrition support or feeding tubes may be needed.

Even with treatment, leaks can become chronic and difficult to resolve. Close follow-up care and cooperation with your treatment team is imperative for the best results. Complete recovery is very likely if the leak is recognized early.

Preventing a Leak

While not every leak can be prevented, the following can reduce your risk:

•     Maintain a healthy weight pre-bariatric surgery - Carrying excess weight puts more pressure on stomach tissues. Losing some weight beforehand when advised can help.
•     Correct any nutritional deficiencies before surgery - Proper nutrient levels promote healing.
•     Stop smoking for at least 6 weeks before and after surgery - Smoking impairs blood flow.
•     Follow all pre-op instructions carefully - This includes diet, exercise and medication guidelines from your surgical team.
•     Take it easy after surgery - Avoid straining, heavy lifting and vigorous exercise that could tear the sensitive stomach pouch.
•     Stay hydrated - Drink adequate fluids as your dietitian recommends to support healing.
•     Keep all follow-up appointments - Blood tests and imaging can catch early leaks before symptoms start.

Seeking prompt care for concerning symptoms and staying in close contact with your bariatric surgery team can help achieve the best results if a leak does occur. While a scary complication, leaks are uncommon and treatable in most cases with early intervention.