• Christine Stroh, Ferdinand Köckerling, Lange Volker, Benedix Frank, Wolff Stefanie, Knoll Christian, Bruns Christiane, Manger Thomas, and Obesity Surgery Working Group, Competence Network Obesity.
• *SRH Municipal Hospital Gera, Gera, Germany †Vivantes Hospital Berlin, Berlin, Germany ‡Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany §StatConsult Magdeburg, Magdeburg, Germany ¶Institute of Quality Assurance at Otto-von Guericke University Magdeburg, Magdeburg, Germany.
• Ann. Surg. 2016 May 1; 263 (5): 949-55.

BackgroundLaparoscopic sleeve gastrectomy (SG) is an upcoming procedure in bariatric surgery and is currently performed worldwide. Staple line leakage, as the most frequent and most feared complication, is still a major concern.MethodsSince 2005 data from patients undergoing bariatric procedures in Germany have been prospectively registered in an online database and analyzed. All patients who had undergone primary SG within a 7-year period were considered for analysis.ResultsUsing the German Bariatric Surgery Registry, data from more than 11,800 SGs were collected between January 1, 2005, and December 31, 2013. Staple line leak rate decreased from 6.5% to 1.4%. Male sex, higher body mass index, concomitant sleep apnea, conversion to laparotomy, longer operation time, a combination of buttresses and oversewing, and the occurrence of intraoperative complications were associated with a significantly higher leakage rate compared with when using either buttresses or oversewing alone. On multivariable analysis, operation time and year of procedure only had a significant impact on staple line leakage rate.ConclusionsOwing to the growing experience a constant decrease in the leakage rate after SG has been observed. Staple line disruption may still lead to sepsis, multiorgan dysfunction, and increased mortality. The results of the current study demonstrated that there are factors that increase the risk of leakage and which would enable surgeons to define risk groups, select patients more carefully, and offer closer follow-up during the postoperative course with early recognition and adequate treatment.

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