Background

Laparoscopic sleeve gastrectomy is a commonly performed bariatric procedure. Sleeve leaks are uncommon, occurring in 1-3% of cases but have potentially devastating consequences. Contemporary management of leaks includes nonoperative and endoscopic options, each with associated failure and reintervention rates. Regardless of approach, essential principles such as early initiation of antibiotics, source control, lavage, and drainage are the mainstays of treatment. For this presentation, we present a sleeve gastrectomy leak managed by laparoscopic transgastric malecot drain placement. After obtaining intraabdominal access, the area abutting the left crus is dissected, freeing a large pocket of purulence. In rotating the gastric sleeve medially, the site of leakage at the uppermost staple line was identified. Prior to drainage control, the perisplenic abscess was bluntly freed, debrided, and irrigated. A pursestring suture with silk is placed and a 20 Fr malecot drain is inserted into the stomach lumen prior to securing the knot. Two additional 19 French blake drains are placed into the retrogastric and perisplenic spaces. Omentum is further buttressed over the leak site. An intraoperative EGD confirms proper controlled drainage. The postoperative course out to 1 year is reviewed.