I've been wondering about the process of healing along the staple line of the sleeve. I know on my surgeons website, there is a description of the stapling and then sewing up the outer edge of the staple line. Does the stomach itself actually start to grow together, sealing things up, or is the leak factor entirely dependent upon the staples and sewing?

It's like any other cut--scar tissue grows over the cut edges and over and around the staples and sutures. Leaks usually occur in the tricky curvature of the stomach to the esophagus at the top and in band-to-sleeve revisions, where oftentimes the stomach tissue has been damaged by the band.

It's like any other cut--scar tissue grows over the cut edges and over and around the staples and sutures. Leaks usually occur in the tricky curvature of the stomach to the esophagus at the top and in band-to-sleeve revisions, where oftentimes the stomach tissue has been damaged by the band.

Thank you. How long is leaking a risk? Just in the healing phase, however long that is?

I was told 6 weeks from my surgeon for the staple line to heal. But I have heard of people having a leak after 9 weeks. Do a search on the site for leak or leaks.

If you smoke, I understand that time could be double.

From what I have read, it appears to me that there are two events that can be quite widely separated in time--there is having a leak and there is detecting a leak. The leaks probably are there from surgery on (there is debate among surgeons, some of whom say all leaks are due to surgical error and some say that some are due to surgical error and some are due to poor healing or poor patient compliance with prescribed diet limitations) but swelling can seal them for a time until it reduces and the leak is apparent. Also, some patients have symptoms for weeks before their surgeons consider the possiblity of a leak and order the proper tests. Most people with leaks heal up fine, it just takes them longer. And remember, the possibility of a leak is really quite small if your BMI is under 50 and if you have an experienced surgeon.

My leak was detected at 3 months, suspected at 9 weeks. They say it was probably there from the beginning and when the swelling went down it started to leak. I complained of left shoulder pain for a month before they considered a leak. It is the top in the tricky part.

Why do you think people with BMI over 50 have higher risk? I had never heard that one before.

Other then that, I have pretty much been told the same thing.

The thing to add is that for revisions, the risk of leaks is higher due to the scar tissue as that kind of tissue is thick and does not "knit" like normal tissue.

From what I have read, it appears to me that there are two events that can be quite widely separated in time--there is having a leak and there is detecting a leak. The leaks probably are there from surgery on (there is debate among surgeons, some of whom say all leaks are due to surgical error and some say that some are due to surgical error and some are due to poor healing or poor patient compliance with prescribed diet limitations) but swelling can seal them for a time until it reduces and the leak is apparent. Also, some patients have symptoms for weeks before their surgeons consider the possiblity of a leak and order the proper tests. Most people with leaks heal up fine, it just takes them longer. And remember, the possibility of a leak is really quite small if your BMI is under 50 and if you have an experienced surgeon.

I wondered the same thing before surgery and asked a similar question. Here's the thread. It has pictures of someone's healed stomach. I hope this helps. http://www.verticalsleevetalk.com/topic/19292-stomach-closure/page__fromsearch__1

Why do you think people with BMI over 50 have higher risk? I had never heard that one before. Other then that, I have pretty much been told the same thing. The thing to add is that for revisions, the risk of leaks is higher due to the scar tissue as that kind of tissue is thick and does not "knit" like normal tissue.

There's a big study just out. I disagree with their conclusion that leaks "occur" after discharge, I think they are detected after discharge. I also think that a 40Fr bougie is pretty big. Research is still coming in on the relationship between bougie size and weight loss, both initial and after some years. Here's the abstract:

Surg Endosc. 2011 Dec 17. [Epub ahead of print] Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Aurora AR, Khaitan L, Saber AA. SourceDepartment of Surgery, University Hospitals Case Medical Center, Lakeside 7, 11100 Euclid Avenue, Cleveland, Ohio, 44106, USA, aaurora@uchs.org.

INTRODUCTION:Sleeve gastrectomy has become a popular stand-alone bariatric procedure with comparable weight loss and resolution of comorbidities to that of laparoscopic gastric bypass. The simplicity of the procedure and the decreased long-term risk profile make this surgery more appealing. Nonetheless, the ever present risk of a staple-line leak is still of great concern and needs further investigation.

METHODS:An electronic literature search of MEDLINE database plus manual reference checks of articles published on laparoscopic sleeve gastrectomy for morbid obesity and its complications was completed. Keywords used in the search were "sleeve gastrectomy" OR "gastric sleeve" AND "leak." We analyzed 29 publications, including 4,888 patients. We analyzed the frequency of leak after sleeve gastrectomy and its associated risks of causation.

RESULTS:The risk of leak after sleeve gastrectomy in all comers was 2.4%. This risk was 2.9% in the super-obese [body mass index (BMI)> 50 kg/m(2)] and 2.2% for BMI > 40. Staple height and use of buttressing material did not affect leak rate. The use of a size 40-Fr or greater was associated with a leak rate of 0.6% compared with those who used smaller sizes whose leak rate was 2.8%. Leaks were found at the proximal third of the stomach in 89% of the cases. Most leaks were diagnosed after discharge. Endoscopic management is a viable options for leaks and was documented in 11% of cases as successful. CONCLUSIONS: Sleeve gastrectomy has become an important surgical option for the treatment of the ever growing morbidly obese population. The risk of leak is low at 2.4%. Attention to detail specifically at the esophagogastric juncture cannot be stressed enough. Careful patient selection (BMI 50kg/m(2) and adopting the use of a 40-Fr or larger bougie may decrease the risk of leak. Vigilant follow-up during the first 30 days is critical to avoid catastrophe, because most leaks will occur after patient discharge. ___________________________

I hadn't seen that study.

My understanding that 32-38 is the range of "standard" sizes that are used. Presumably better weight loss, but higher risk of complications the smaller it is. I am pretty sure I got a 38, so time will tell...

I wondered the same thing before surgery and asked a similar question. Here's the thread. It has pictures of someone's healed stomach. I hope this helps. http://www.verticals...__fromsearch__1

Great thread Penpen, thank you! Thank you everyone else for your input. It IS comforting. My BMI is almost 55, so some of this info is a bit disconcerting, but does not kill my resolve to get this done. The things I deal with on a daily basis and could face in the future make it worth it. Any other input is welcome.

-danielle

There's a big study just out. I disagree with their conclusion that leaks "occur" after discharge, I think they are detected after discharge. I also think that a 40Fr bougie is pretty big. Research is still coming in on the relationship between bougie size and weight loss, both initial and after some years. Here's the abstract:

Surg Endosc. 2011 Dec 17. [Epub ahead of print] Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Aurora AR, Khaitan L, Saber AA. SourceDepartment of Surgery, University Hospitals Case Medical Center, Lakeside 7, 11100 Euclid Avenue, Cleveland, Ohio, 44106, USA, aaurora@uchs.org.

INTRODUCTION:Sleeve gastrectomy has become a popular stand-alone bariatric procedure with comparable weight loss and resolution of comorbidities to that of laparoscopic gastric bypass. The simplicity of the procedure and the decreased long-term risk profile make this surgery more appealing. Nonetheless, the ever present risk of a staple-line leak is still of great concern and needs further investigation.

METHODS:An electronic literature search of MEDLINE database plus manual reference checks of articles published on laparoscopic sleeve gastrectomy for morbid obesity and its complications was completed. Keywords used in the search were "sleeve gastrectomy" OR "gastric sleeve" AND "leak." We analyzed 29 publications, including 4,888 patients. We analyzed the frequency of leak after sleeve gastrectomy and its associated risks of causation.

RESULTS:The risk of leak after sleeve gastrectomy in all comers was 2.4%. This risk was 2.9% in the super-obese [body mass index (BMI)> 50 kg/m(2)] and 2.2% for BMI > 40. Staple height and use of buttressing material did not affect leak rate. The use of a size 40-Fr or greater was associated with a leak rate of 0.6% compared with those who used smaller sizes whose leak rate was 2.8%. Leaks were found at the proximal third of the stomach in 89% of the cases. Most leaks were diagnosed after discharge. Endoscopic management is a viable options for leaks and was documented in 11% of cases as successful. CONCLUSIONS: Sleeve gastrectomy has become an important surgical option for the treatment of the ever growing morbidly obese population. The risk of leak is low at 2.4%. Attention to detail specifically at the esophagogastric juncture cannot be stressed enough. Careful patient selection (BMI 50kg/m(2) and adopting the use of a 40-Fr or larger bougie may decrease the risk of leak. Vigilant follow-up during the first 30 days is critical to avoid catastrophe, because most leaks will occur after patient discharge. ___________________________

BTW......what is a bougie???

BTW......what is a bougie???

look at this video, it contains a really good explanation of what a bougie and shows you how it is used:

Very helpful. I don't hink my doctor puts anything down my throat though... is that Dr. Alverez's technique? Or do I just have an incomplete understanding of the procedure?

look at this video, it contains a really good explanation of what a bougie and shows you how it is used:

Great video! Thanks for sharing. It leads to other helpful videos too!

My bougie is 40 fr. They believe my leak was there from the beginning and only opened once the swelling went down. I think the leak tests before leaving the hospital are somewhat a false reassurance - you have to be hyper aware of your body and stay on top of any problems and insist on testing if you have a problem and don't get better.