Gastric Sleeve Leak: Symptoms, Causes & Treatment

What exactly is a gastric sleeve leak?

When it comes to gastric sleeve surgery, it’s known for being one of the safest weight-loss surgeries available. However, like any surgery, it carries some risks. One of the more serious complications that can arise is a gastric leak. Though it’s pretty rare only about 1 in every 200 patients experience it it’s a condition that needs immediate attention, as it can become life-threatening if not handled correctly. Even with this risk, the overall benefits of gastric sleeve surgery far outweigh the chances of having a leak.

Why does a gastric leak happen?

So, what exactly causes a gastric leak after surgery? A gastric leak happens when a hole or gap forms along the staple line your surgeon used to create the new stomach pouch, which is shaped like a banana. This pouch is designed to limit the amount of food you can consume. If there’s a gap or tear, stomach juices can leak out into the abdominal cavity, which can lead to very serious infections.

In a study published in the Alexandria Journal of Medicine, it was found that the majority of leaks happened in patients who had laparoscopic gastric sleeve surgery. Around 70% of leaks happen at the area where the esophagus connects to the stomach.

Leaks generally happen when the staples that hold the stomach pouch in place fail, or if the area doesn’t heal properly, which prevents the formation of a complete, secure seal. The issue with leaks is that gastric juices contain bacteria, which can cause major health problems if they escape the digestive system. If a leak is not discovered and treated in time, it can lead to complications like:

Gastric ulcers
Fistulas (large holes in the GI tract)
Infections that can lead to sepsis and septic shock
Multiple organ failure

The key here is early detection catching a leak early can make all the difference, preventing severe complications that can arise from a delayed diagnosis.

What are the symptoms of a gastric leak?

The symptoms of a gastric leak can vary significantly from person to person. In some cases, you might not notice any issues right away, and things could get worse over time. The most common signs include stomach and abdominal pain, along with pain in your shoulders or chest. This discomfort tends to get worse as time passes.

Other symptoms to be aware of are:

Abdominal pain and bloating: You may experience discomfort after eating, and some people even report diarrhea.
Unexpected weight loss: Losing weight without trying could signal something’s wrong.
Nausea or vomiting: Both can be early warning signs of a leak.
Heartburn: If acid reflux suddenly becomes more intense or doesn’t go away, it might indicate a leak.
Fluid leaking from your abdomen: If you notice any fluid leaking from an open wound on your stomach area, this is a major red flag.
Breathing issues: If you notice you’re breathing faster than usual or find it hard to breathe (more than 18 breaths per minute), it’s time to get checked out.
Dizziness or lightheadedness: This could be caused by infection or dehydration.

Blood tests may show a higher white blood cell count and elevated C-reactive protein levels, both of which indicate inflammation or infection.

How is a gastric leak diagnosed?

Diagnosing a gastric leak can be tricky, because there isn’t one single test that will definitively confirm a leak. Instead, doctors will look at your symptoms and use a variety of tests to help make the diagnosis. Here are some of the methods used to detect leaks:

Upper endoscopy: This is when a flexible tube with a camera is inserted through your mouth to examine your stomach and esophagus for leaks.
Contrast X-ray: You’ll drink a special contrast liquid, which helps the doctor see the areas where a leak may be happening.
Fistulogram: If a fistula (an abnormal passage between the GI tract and the outside of the body) is suspected, contrast dye is injected into a wound, and an X-ray is taken.
Ultrasound, CT scan, or MRI: These imaging tests give a detailed view of your stomach and intestines, helping your doctor locate the leak.

In some cases, if these tests don’t show a leak but your symptoms persist, your doctor may recommend emergency surgery to address the issue.

Types of gastric leaks

Gastric leaks are typically categorized by when they occur after surgery:

Early leaks (Day 1 – 3): These leaks happen in the first few days after surgery and account for about 95% of all leaks.
Intermediate leaks (Day 4 – 7): These occur between the fourth and seventh day after surgery.
Late leaks (Day 8 and beyond): These leaks are less common and tend to occur later in the healing process, usually due to issues with how the stomach heals.

Leaks can also be classified by where they happen in the stomach or how severe they are. Some leaks are easy to detect (clinical leaks), while others are more subtle (subclinical leaks).

Can a gastric leak happen after one year?

It’s pretty rare for a leak to develop more than 30 days after surgery, as most leaks are detected during the first month. However, there are some rare cases where a leak may occur months or even years later, often due to problems with the sutured area that weren’t caught during the initial post-surgery recovery.

What increases the risk of a gastric leak?

Several factors can increase the likelihood of experiencing a gastric leak. The risk is higher if you were more obese before surgery, but other factors may also play a role:

Being male: Men tend to have a slightly higher risk.
Having other health conditions: Issues like diabetes or high blood pressure can interfere with your body’s healing process.
Having had previous abdominal surgeries: Scar tissue from past surgeries can make healing more complicated.

How is a gastric leak treated?

If a gastric leak is caught early, treatment is generally easier. That’s why it’s crucial to seek medical help as soon as you notice symptoms. Treatment depends on the type and cause of the leak, and it may include:

Antibiotics: These are used to treat or prevent infections that could be caused by the leak.
Nutritional support: IV fluids or a feeding tube can be used to provide the nutrients you need while the leak heals.
Negative Pressure Wound Therapy (NPWT): For leaks that occur outside the body, this technique uses a vacuum to help remove excess fluid and pull the wound edges together.
Emergency surgery: In cases of early leaks, surgery is the fastest way to clean out the infection and seal the hole in the stomach.

For acute leaks (those that occur in the first few days), the main goal is to drain the leaking fluid to prevent further infection. For chronic leaks (those lasting more than a month), non-surgical treatments are usually preferred, though some surgeons may suggest converting the procedure to a gastric bypass.

How to lower the risk of a gastric leak

While you can’t guarantee a leak won’t happen, there are steps you can take to reduce the risk:

Get plenty of rest after surgery: This gives your body time to heal properly.
Follow post-op instructions: Be sure to take your medications as prescribed and stick to your diet.
Don’t rush back to solid foods: It’s important to stick to the recommended liquid diet until your doctor says it’s safe to move to solids.
Report symptoms promptly: If something doesn’t feel right, don’t wait call your doctor.
Avoid NSAIDs: Drugs like ibuprofen can cause ulcers and other complications.

What should your doctor do to prevent a gastric leak?

Your bariatric surgeon plays a key role in minimizing the risk of leaks. Some things they’ll do to reduce your chances of complications include:

Evaluating your overall health: Your doctor will assess your BMI and medical history to make sure you’re a good candidate for surgery.
Reinforcing the staple line: Some surgeons use additional sutures to reinforce the staple line, reducing the risk of leaks.
Testing for leaks during and after surgery: Your medical team should check for leaks before you leave the hospital.
Regular follow-ups: Even if you feel fine, attending all your follow-up appointments is crucial to catch any problems early.

By taking these precautions and following your doctor’s advice, you can lower the chances of experiencing a gastric leak and enjoy the benefits of your surgery with fewer complications.