Hi Friends,

Leaks seem to be very rare but do you agree that it sounds like 2 weeks post-op is when they are most likely? From what I read, I think that may be the case. I have a theory about what might cause them.

Those of you who are nurses like me know that about 2 weeks post tonsillectomy, when the "scabs" fall off the wounds in the throat, there is an increased incidence of hemorrhage. Well, I wonder if two weeks post VSG when the stomach incision "loses it's scab", there might be a greater chance of a tiny opening showing up where it falls off. That is also a time when many people start to advance their diet, and maybe put a bit more into the sleeve, which could make the opening a little bigger still.

Voila. A leak!

Sound plausible?

Some do leak tests and some don't. LapSF used to do leak tests in the OR and after. But they never found a leak that way. Then, people would leave the hospital and a few days later, they'd have a leak! So they speculated that something about the leak test in the OR was stressing the staple line and they stop doing them.

I watched an operation online where instead of leak testing the sleeve they leak tested the stomach after it was removed. The idea was that they were stapled simultaneously, so if one leaked, then the other would too. Not sure if I buy into that, given that we're talking about living slippery tissue, but it's another interesting theory. I don't think my doc did an OR leak test. Just the post-op radiograph swallow test. It was kinda cool, by the way, to see my shriveled up sleeve on the x-ray with the contrast flowing through it. :drool5:

LapSF is publishing their results right now in a peer-reviewed journal. They are in the editing phase, I think. They don't oversew (some docs think that stresses something or other too much), but they use this material (Buttress?) that's kind of like a gauze and the staples go through it. Then they go back and glue around the edges.

About testing the removed stomach.... that isn't going to show all the leaks. Something can be not lined up right on one side but okay on the other. IMHO.

My doctor only does a leak test in the OR. He will do it after if symptoms are present.

Hmmmm...Maybe I'm just cantankerous, but I don't like the idea of having foreign substances (gauze and glue) inside me unless it is absolutely necessary. The staples are necessary, but I'm not so sure about the gauze'n glue, especially since there seems to have been such a very low incidence of leaks without them.

I like the idea of dropping the leak test...or maybe they could just modify it, and not put any pressure on the new stomach...just fill it gently to see if anything leaks out. Testing it under pressure seems riskier, and since the patient is not supposed to be drinking enough to put it under pressure, why put pressure on it in the OR? Give it time to heal!

cajun

LapSF is publishing their results right now in a peer-reviewed journal. They are in the editing phase, I think. They don't oversew (some docs think that stresses something or other too much), but they use this material (Buttress?) that's kind of like a gauze and the staples go through it. Then they go back and glue around the edges.

About testing the removed stomach.... that isn't going to show all the leaks. Something can be not lined up right on one side but okay on the other. IMHO.

But gauze and glue dissolve. Those staples are in there forever. I know they are necessary, but it bugs me. I'm still annoyed that I have surgical clips in me from getting my gallbladder out. :001_tongue:

Also, if you aren't going to use the buttress stuff, you should probably oversew and then you have stitches (that also dissolve eventually).

So you get extra foreign crap in there regardless... :wink:

My take on it is, every surgeon has their own little voodoo they do and you go by their stats. If they have good stats, their voodoo works for them, and the details don't matter so much.

Yep, guess you're right. I did not know the gauze was dissolvable.

Don't you wish the staples were too??!!

Yep! I sure do!

cajun- I can't remember where I found that. I just thought it was cute!

I just met with my surgeon on Friday for the first time. He said that he performs a leak test in the OR, then an Upper GI the day after. He said that he uses the Buttress to staple method. I'm glad to read that LapSF also uses the Buttress method.

I feel like I'm on information overload!

I had an upper GI before they even allowed me to drink water day after surgery, it showed potential leaks and or problems. That is standard from my surgeon. IT was nasty, but I got to see my sleeve on screen, super small!

Thanks Rcarter. I'm so new at this. It's good to know that my doc does what others do.

Of course, I am super new too and only one week out but learning!

I am excited for you lee!