DELAYED PERFORATIONS AFTER SLEEVE GASTRECTOMY POSE A PROBLEM
As I write this, I am taking care of a gentleman who is extremely ill, in critical condition and in the intensive care unit of one of our hospitals having undergone a sleeve gastrectomy approximately three months ago. He experienced one of the more devastating complications of this procedure, namely a delayed perforation of the stomach. Such perforations occur in sleeve gastrectomy more so than with other procedures. In fact, I have seen several of these devastating delayed perforations in sleeve gastrectomies while they are nearly unheard of in the other weight loss procedures (with the exception of perforated ulcers, which can occur years later, usually as a result of Motrin, Aleve and other non-steroidal anti-inflammatory drugs attacking the stomach lining).
The phenomenon of a delayed perforation after gastric sleeve procedure is one that is increasingly discussed at meetings, but not fully understood. There may be a phenomenon of local ischemia, meaning a local area of lack of blood supply along the gastric staple line or it may be due to other factors we may not fully comprehend. Another theory is that some bleeding, bruising or hematoma has formed along the staple line and as this breaks down and is absorbed it creates a perforation. What we do know is that the stomach tube or sleeve is a high pressure system after the sleeve gastrectomy procedure is performed. With most of the stomach volume having been removed, the pressure as measured within the remaining stomach tube is higher than it would be after gastric bypass surgery or after Lap-Band. The long staple line itself creates some vulnerability to perforation and this high pressure may play a role. But whatever the exact cause is, it is phenomenon that we do not fully understand and we cannot fully prevent. It is particularly devastating because it can occur weeks or months after surgery when a person appears to have been healing up nicely.