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Does Tissue Ischemia Actually Contribute To Leak after Sleeve Gastrectomy? An Experimental Study

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Abstract

Background

Staple line leak, although rare, is among the most common postoperative complications after sleeve gastrectomy (SG) and usually occurs in the gastroesophageal (GE) junction. Increased intragastric pressure, regional ischemia, and technical failure of stapling devices have been reported as the main risk factors of postoperative leak. The aim of this study was to evaluate the impact of ischemia and intraluminal pressure in leak appearance.

Methods

Landrace swine (n = 12) were subjected to SG and total gastrectomy subsequently. Lactic acid, glycerol, and pyruvate were measured by microdialysis in GE junction and pylorus before and nine times after operation, and lactate/pyruvate (L/P) ratio was calculated as well. Moreover, ex vivo air was insufflated inside the tubularized stomach till a rupture of the staple line occurs. Maximum air pressure reached and location of rupture were recorded.

Results

Increase of lactic acid and L/P ratio were demonstrated in GE junction measurements; however, when the measurements between GE junction and pylorus were compared, no statistically significant differences were found, with the exception of a slightly increased lactate concentration in pylorus in the midst of measurements. The maximum air pressure recorded varied from 3 to 75 mmHg (mean 24.5 mmHg) and the majority of ruptures (n = 8) occurred in GE junction. In one of them, clip displacement was noticed.

Conclusions

No evidence of increased ischemia in GE junction compared to pylorus was recorded. Increased intraluminal pressure and stapling malfunction may play the most important role in leak appearance.

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Acknowledgments

Maria Natoudi received a scholarship fund by the Experimental - Research Center ELPEN. Apostolos Papalois is the director of the Experimental - Research Center ELPEN who sponsored the study.

Conflicts of Interest

Dimitrios Theodorou, Apostolos Papalois, Panagiotis Drymousis, Leonidas Alevizos, Stylianos Katsaragakis, Georgios Zografos, Emmanouel Leandros, and Evangelos Menenakos have no conflicts of interest.

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Authors and Affiliations

  1. First Department of Propaedeutic Surgery, Hippokration Hospital, Athens Medical School Greece, 114 Queen’s Sofia Avenue, Athens, Greece

    Maria Natoudi, Dimitrios Theodorou, Panagiotis Drymousis, Leonidas Alevizos, Stylianos Katsaragakis, Georgios Zografos, Emmanouel Leandros & Evangelos Menenakos

  2. Experimental - Research Centre, ELPEN Pharmaceutical, 95 Marathonos Avenue, Pikermi, Athens, Greece

    Apostolos Papalois

  3. Pipinou 52, 11251, Athens, Greece

    Leonidas Alevizos

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  1. Maria Natoudi
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  2. Dimitrios Theodorou
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  3. Apostolos Papalois
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  4. Panagiotis Drymousis
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  5. Leonidas Alevizos
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  6. Stylianos Katsaragakis
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  7. Georgios Zografos
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  8. Emmanouel Leandros
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  9. Evangelos Menenakos
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Correspondence to Leonidas Alevizos.

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Natoudi, M., Theodorou, D., Papalois, A. et al. Does Tissue Ischemia Actually Contribute To Leak after Sleeve Gastrectomy? An Experimental Study. OBES SURG 24, 675–683 (2014). https://doi.org/10.1007/s11695-013-1156-z

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