• Simon W Nienhuijs, Uzay Kaymak, Erik Korsten, and Marc P Buise.
• Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands. Electronic address: simon.nienhuijs@cze.nl.
• Surg Obes Relat Dis. 2016 Mar 1; 12 (3): 535-539.

BackgroundLeak after a sleeve gastrectomy (SG) is a severe complication. Risk factors, such as regional ischemia, increased intraluminal pressure, technical failure of the stapling device, and surgeon error, have been reported.ObjectivesIt was hypothesized that intraoperative hypotension is another risk factor for leak, similar to that reported for colorectal surgery.SettingTertiary teaching hospital in The Netherlands.MethodsResults of a 7-year cohort of primary SGs were reviewed in relation to multiple intraoperative blood pressure measurements. The thresholds for the mean pressure were 40 to 70 mm Hg and for the systolic pressure 70 to 100 mm Hg. Only continuous episodes of 15 and 20 minutes were included.ResultsTwenty-four leaks were identified in a cohort of 1041 primary SGs. Episodes of systolic blood pressure<100 mm Hg for 15 min (P = .027) and 20 minutes (P = .008) were significantly related to a staple line leak. An episode of mean blood pressure<70 mm Hg for 20 min was significantly related to leak (P = .014). Episodes with lower thresholds of pressure occurred less frequently and revealed no significant differences. Other identified risk factors were smoking (P = .019), fast-track recovery program (P = .006), use of a tri-stapler (P = .004), and duration of surgery (P = .000). In a multivariate analysis, only intraoperative systolic pressure<100 mm Hg for 20 minutes remained significant (odds ratio, 2.45; P = .012).ConclusionsIntraoperative hypotension may contribute independently to a leak after SG.Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

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