Post-operative bleeding complications in laparoscopic sleeve gastrectomy: sources, solutions and lessons learnt from a single cohort of patients
Post-operative bleeding is a major but infrequent complication in laparoscopic sleeve gastrectomy (LSG). There is paucity in the literature on management of this complication. This paper seeks to review the presentation of post-operative bleeding complications after LSG in a single cohort of patients and highlight the surgical and non-surgical methods of treatment. A retrospective study of 409 LSG patients performed in a tertiary hospital, Singapore General Hospital (SGH) since 2008. Patients who encountered post-operative bleeding complications, defined as requiring blood transfusion or re-laparoscopy for haemostasis, were identified from a prospectively recorded database. The presentation, source of bleeding and management were recorded and presented. Five out of 409 (1.2%) patients were diagnosed with post-operative bleeding. Two patients were treated conservatively requiring only blood transfusion and 3 patients were surgically explored with laparoscopy, 2 were from staple line bleeding (SLB) and suture haemostasis performed. In 1 patient, the source of bleeding was not identified intraoperatively and CT angiography performed post-operatively showed active contrast bleeding near short gastric arteries and gastroepiploic artery. Gel foam and coil embolization was performed and the bleeding was controlled. Average hospitalization stay due to post-operative bleeding was 7.3 days compared to 2.3 days for those without. Post-operative bleeding after LSG occurred at the staple line and branches of the right gastro-epiploic artery and short gastric arteries. Bleeding may stop spontaneously or require haemostasis by operative or endovascular means. CT angiogram is proposed to locate the source of bleed and subsequent embolization of bleeding arteries maybe possible, avoiding the need for re-operation. Bleeding from the staple line requires surgical haemostasis.