De Angelis F, et al. – A retrospective study was designed to examine the 4–year experience of a high–volume center with respect to the prevention and management of perioperative laparoscopic sleeve gastrectomy (LSG) bleeding. The obtained data indicates that, in a high–volume center, the expected incidence of bleeding after laparoscopic sleeve gastrectomy is 1.7% even after the adoption of all preventive strategies. The intraoperative protocol for detecting silent bleeding was effective, and no cases of bleeding were observed since its application. The data indicated that the conservative management of postoperative bleeding should be considered as a high–risk condition for late leakage.

Methods

• Between June 2012 to June 2016, researchers reviewed the prospectively maintained database.
• They analyzed outcomes, especially perioperative bleeding (until patient discharge), its management, and follow–ups.

Results

• In this study, out of 870 LSG (603 females, 267 males), 31 cases (3.5%) of postoperative complications were registered: bleeding was the most frequent complication (1.9%).
• They laparoscopically managed hemoperitoneum in 9/17 patients (52.9%) with only one conversion to laparotomy (11.1%).
• It was demonstrated that conservative treatment successfully controlled bleeding in 8/17 patients (47.1%).
• Nevertheless, four patients (50%) developed an infected hematoma; two of them were treated conservatively with a CT–guided drainage, and the other two were complicated by late gastric leak treated laparoscopically. No mortalities occurred in the investigated cases.