Perioperative complications of sleeve gastrectomy: review of the literature

Sleeve gastrectomy (SG) has known a spectacular rise worldwide during the last decade. The absence of digestive anastomosis simplifies the surgical technique, reducing anastomosis-related complications such as fistula, stricture, and marginal ulcer. Furthermore, the digestive continuity is respected and the pylorus, that regulates gastric emptying, and duodenum, where calcium, B vitamins and iron are absorbed, are not bypassed. Despite the multiple advantages SG also has specific complications such as bleeding, stenosis, portal thrombosis and leak. The staple line leak at the esophago-gastric junction is the most feared complication and its prevention remains difficult, as the involved mechanisms have been only partially elucidated. Its management is long and requires a multidisciplinary technical platform including intensive care unit, digestive endoscopy and interventional radiology as well as a specialized surgeon. The aim of this review is to explain in detail the perioperative complications of SG, their prevention and treatment, referring to the most recent available literature.