Staple line leaks after bariatric surgery are uncommon, but one of the main short-term risks we look for after a sleeve gastrectomy, gastric bypass, or duodenal switch. These leaks are a risk for about the first four weeks surgery. To understand what a staple line leak is, first you should know what the staples look like and how the stapler functions!
Watch this quick video that shows the staplers that are used in the state-of-the-art technique we utilize at JourneyLite.
We use Medtronic’s new Signia smart stapler and Tissea or Evicel fibrin sealant on all our staple lines. The Signia stapler is the first of it’s kind, utilizing Adaptive Firing™ technology to measure the tissue thickness and adjust accordingly to enable the formation of more perfect staple lines. After the staple line is complete, then a fibrin sealant product such as Evicel is applied which forms a fibrin clot, like a glue, to further reduce the risk of bleeding and potentially leaks as well.
These staplers fire 6 rows of tiny little titanium staples and divides down the middle, leaving 3 rows of staples on each side of the two staple lines. Three rows of staples provides for a stronger staple line and reduces the chance of leaks and bleeding.
While staple line leaks for gastric bypass and SIPS/SADI can occur early, a staple line leak after a sleeve usually happens in the 3rd or 4th week after surgery, when a few staples pop out (usually for unknown reasons). This can allow gastric contents to leak out from the sleeve and into the abdominal cavity. Most of the time when this happens it results in a small fluid collection, or “abscess”, next to the sleeve. The risk of a staple line leak after bariatric surgery is low, in most published studies around 1-2%. With this new equipment, our leak rate is around 0.5% on cases that are not revisions.
- What are the signs of a leak?
- Surgery type:
- Sleeve: The patient is usually 2-4 weeks out from surgery
- Bypass: The patient is usually less than 7 days out from surgery
- SIPS: The patient is usually less than 1 month out from surgery.
- Fevers (over 100.4)
- Left upper quadrant or diffuse belly pain
- Increasing pain each day (as opposed to normally decreasing pain)
- Rarely ever happens after 6th week
- Surgery type:
- How are leaks diagnosed?
- CT scan
A CT scan is often the first test done when staple line leaks after bariatric surgery are suspected. In the image above next to the red circle you can see a bright white line, which is the staple line. Within the red circle you can see some air bubbles (which appear black). These air bubbles are outside of the staple line, showing that some air that the patient swallowed is now outside of the sleeve.
CT scans are good not only for finding staple line leaks after bariatric surgery, but also for treating them. In some cases the radiologists can insert a small drain tube (called a percutaneous drain) into the area where the leak is, to allow any infection to drain out. This drain is then left in until the leak heals.
- Upper GI
Upper GI’s are xrays that are done under live fluoroscopy while the patient swallows some contrast dye. The contrast dye shows up as white on an xray. In the xray above the sleeve is the long column of white dye that heads up towards the upper left corner of the xray. You can see a small amount of dye within the red circle, that is outside of the sleeve. This indicates a leak.
- Endoscopy
An endoscopy is when we sedate a patient and insert a scope into the mouth, down through the esophagus, and into the sleeve. They are useful mainly for treating leaks, but can at times be used to diagnose them as well. The image above shows the view through the endoscope of a sleeve. Within the red circle you can see a small pinhole leak. In this case multiple treatment options could be used, including clips or endoscopic sutures to close the leak, or more commonly inserting an esophageal stent to cover the leak.
Depending on the type, stents are left in place for around 2-8 weeks. This allows time for the leak to heal while the stent provides coverage to prevent further leakage. During this time usually a drain has already been put in already, and the patient is given IV antibiotics and IV nutrition. Although many leaks will heal without further intervention, some patients require surgery to correct those that will not heal with stenting or other endoscopic treatments.
In summary, staple line leaks after bariatric surgery are uncommon but a known possibility. They are not life threatening as long as they are promptly treated, and they usually can be resolved without surgery. At JourneyLite Physicians we take every step we can to reduce your risk of a complication after surgery, but the patient must participate also. In order to reduce your risk of a leak, be sure to follow our dietitian’s instructions on your post-op diet!
Kathy Elkins says
Does exercising too strenuously after surgery contribute to staple line leaks?
Dr. C says
No, it does not but patients should wait a few weeks before strenous exercise!
Dr. Trace Curry
Medical Director
JourneyLite Physicians
Namita says
6 weeks of my surgery is completed. Can I start excersize? Can I atleast do cycling
Trace Curry says
We allow our patients unlimited activity after week 4, but check with your surgeon.
Dr. Trace Curry
Medical Director
JourneyLite Physicians
Adrienne says
I’ve heard eating solid foods can cause a leak. Is that true?
Dr. C says
Eating solid foods too early could possibly cause a leak, so its important to follow the dietary progression advocated by your surgeon.
Dr. Trace Curry
Medical Director
JourneyLite Physicians
Namita says
Early means, how many weeks? I had little food in 4th week and I am getting abdominal pain. I am worried
Trace Curry says
Usually leaks present in weeks 0-4. After the 4th week it is rare.
Dr. Trace Curry
Medical Director
JourneyLite Physicians
Sheila says
I frequently sneeze hard. Is this anything to worry about?
Trace Curry says
Probably not, I have heard this from a couple of patients after band and sleeve though.
Paula Trimble says
I don’t think I have a leak but I’m not sure. What does the pain feel like? Muscle, stabbing, dull? I have this pain in my left stomach area today that feels like a sore muscle.
Trace Curry says
Usually left upper quadrant pain and low grade fevers are what you see with a leak. However a CAT scan is required to diagnose or exclude for sure.
Dr. Trace Curry
Medical Director
JourneyLite Physicians
Julie Sewell says
Can you get or have had a leak 10mths after surgery?
Trace Curry says
It’s not impossible but its very rare and I’ve never seen it.
Dr. Trace Curry
Medical Director
JourneyLite Physicians
Cindy says
I had my sleeve surgery 2 weeks ago and I noticed a bulge on my abdomen close to the main incision location. I have not fever, no pain. What can that be? I have pain in my chest when ever I eat, is that normal?
Trace Curry says
We do nicotine testing on a case-by-case basis.
Dr. Trace Curry
Medical Director
JourneyLite Physicians
ANNA SLATER says
THANKS TO DR. U AND ALL OF HIS TEAM SORRY I WAS SO MUCH TROUBLE
Richard Gire says
Dr Curry
I had my VSG today with Dr. Udelhoffen and his team. They were all very professional and helpful all the way through this day. I wanted you to know how pleased I am that I choose JourneyLite for my surgery.
Trace Curry says
Sorry for the delay but thanks for the kudos!
Dr. Trace Curry
Medical Director
JourneyLite Physicians
Kathleen LaBrecque says
I am having my Sleeve on November 25 of this year and I am looking forward to having a better and healthier life.
Trace Curry says
That’s awesome, see you soon!
Dr. Trace Curry
Medical Director
JourneyLite Physicians
Kirsten Domenech says
What is the best way to find out if a leak has healed? Does and upper gi usually work for this?
DrCurry says
It usually has to be a combination of tests, including upper GI, sometimes + endoscopy and/or CT scan.
Dr. Trace Curry
Medical Director
JourneyLite Physicians
Mike Dugan says
1) In the video I saw “loose” (fired but dangling” staples., what happens to those?
2) What does the staple line look like (from inside the abdominal cavity) a year? I’ve heard that the scar tissue envelops the entire three rows of staples that are left inside, thus covering them all, and perhaps making the dangling staples question irrelevant.
3) How “strong” is the staple line a year+ after surgery compared to before the VSG?
4) How long before being able to get back in a pool, and how long before being able to SCUBA dive again?
DrCurry says
Hi there these are great questions – any loose staples simply get incorporated into the surrounding tissue. They are tiny and harmless, I’ve never seen an issue caused by them in 20+ years. As for your second question, I don’t know that it’s ever been really tested, but once the staple line heals it should be just as strong as it was prior to sleeve. And lastly, I would wait around a month before pool or SCUBA, after that it’s fine.
Dr. Trace Curry
Medical Director
JourneyLite Physicians
Melissa says
I was sleeved on 12/30 and last week on Friday i lifted tiles no more then 10lbs but i was moving tile all day, could i have caused i leak? i have bad abdominal pain. – no fever, no dizzy, no rapid heart rate.
DrCurry says
Hi there lifting will not cause a leak, however there is no way to know if a patient has a leak or not without evaluating them in person so definitely get in for an appointment ASAP.
Angie says
What will happen if i feel okay to eat 1 week after a vgs?
DrCurry says
No matter how you feel, follow your surgeons instructions related to your diet. It’s very important!