The Incidence of Leak Following Laparoscopic Sleeve Gastrectomy with Pyloric Balloon Dilatation

Background: Laparoscopic sleeve gastrectomy is rapidly increasing in popularity, its rapid rise in popularity coupled with good initial results suggest that it will be a major com-ponent of patient care for the treatment of morbid obesity and its comorbid medical problems for years to come in the future. Staple-line disruption is the most life-threatening complication after LSG many hypotheses and solutions were suggested to overcome this problem, however no significant effect. Methods: Pyloric balloon dilatation was done to 20 mor-bidly obese patients undergoing sleeve gastrectomy and the results were compared to another group of 20 LSG patients in which no pyloromyotomy was done. Results: We had intra-operative complications in the form of staple line bleeding in 8 patients (20%) and serosal tear in 2 patients (5%) for whom buttressing was done and staple line disruption in only one patient (2.5%) which was over-sewn by hand. Regarding post-operative complications we had 2 cases (10%) of proximal staple line leak in the pyloromy-otomy group in the early post-operative period for which gastric stents were inserted. We had one case of mortality after leak. Conclusion: Pyloromyotomy has reduced the gastric pressure to an extent that was adequate to relieve heart burn and other symptoms of GERD but only in the immediate post operative period, was not sustained for a long period and also it was not enough to prevent staple line leak although this leak was not primarily due to high intra-gastric pressure but definitely this high pressure played a role in the progress of leak.