Introduction: Staple line disruption is a rare and difficult to manage complication after laparoscopic sleeve gastrectomy. The incidence is approximately 1% and the optimal approach unknown. We present a case of a laparoscopic sleeve gastrectomy staple line disruption managed successfully with a gastric T tube placed laparoscopically.

Methods: A 50-year-old female with a preoperative BMI of 40.1, a known history of hypertension and hypercholesterolemia. She underwent laparoscopic sleeve gastrectomy at an outside institution two weeks prior. Patient was noted to be septic with stable vital signs, a CT of the abdomen and pelvis showed a large loculated fluid collection lateral to the sleeve gastrectomy. At diagnostic laparoscopy, the patient was found to have a staple line disruption. After copious irrigation and debridement, a long gastric T tube was placed and the staple line disruptions were oversewn and patched with omentum.

Results: Patient postoperatively was kept NPO and started on TPN and broad-spectrum antibiotics. Despite a prolong course and multiple re-admissions for fever,abdominal pain or PICC line infection, she remained clinically stable without further surgical intervention. On her 2-month postoperative care, the gastric T tube was removed after an UGI and methylene blue test were negative for leaks. A CT of the abdomen was also performed and showed a resolving fluid collection without evidence of PO contrast extravasation.

Conclusion: Staple line disruption after a laparoscopic sleeve gastrectomy can be managed operatively with a gastric T tube, negative pressure drainage and a course of conservative care (NPO, antibiotics, and TPN.)