Send to

Choose Destination
Obes Surg. 2017 Nov;27(11):2927-2932. doi: 10.1007/s11695-017-2731-5.

Sleeve Gastrectomy Postoperative Hemorrhage is Linked to Type-2 Diabetes and Not to Surgical Technique.

Author information

Bariatric center, Herzliya Medical Center, 7 Ramat Yam St, 4685107, Herzliya, Israel.
Bariatric center, Herzliya Medical Center, 7 Ramat Yam St, 4685107, Herzliya, Israel.
Coagulation Unit, Institute of Hematology, Rabin Medical Center, Petah Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel.



The degree, prevalence, and risk factors linked to sleeve gastrectomy (SG) postoperative hemorrhage (POH) have not been fully defined.


An analysis was conducted on a prospectively collected database of 394 consecutive primary SGs performed in a single practice from January 2014 to December 2015.


(1) acute POH, defined by red blood cell (RBC) transfusion and/or re-exploration; (2) subclinical POH, defined by postoperative hemoglobin drop (HgbD) >one standard deviation above mean. Variables tested included three surgical techniques: normal stapling (n = 137), "tight" stapling, (n = 142) and oversewing, (n = 115); age; gender; body mass index (BMI); co-morbidities; and elevated postoperative systolic blood pressure.


Acute POH occurred in 11/394 patients (2.8%) and subclinical POH (HgbD > 2.2 g/dL) was detected in 27/312 (7.7%) of patients with available HgbD data. Acute POH patients had a mean HgbD of 5.43 ± 1.40 g/dl (p < 0.001) reflecting approximately 38.6% ± 10.0% of total blood volume. No difference in prevalence of POH was observed for the different surgical techniques. Compared with non-bleeders (n = 312), acute and subclinical POH patients (n = 38) had 52.6 vs. 27.2% prevalence type-2 diabetes (T2D) and 60.5 vs. 40.1% prevalence of dyslipidemia and higher mean preoperative hemoglobin 14.3 ± 11 vs.13.5 ± 1.2 (p < 0.05 for all). On regression analysis, only T2D (OR 2.6; 95% CI 1.2-5.6) and higher level of preoperative hemoglobin (OR 1.7; 95% CI 1.3-2.4) were independent risk factors for POH.


In this study, acute and subclinical POH were primarily linked to T2D and not to surgical techniques. Special consideration is recommended for patients with T2D undergoing SG.


Bleeding; Complications; Dyslipidemia; Hemorrhage; Laparoscopic sleeve gastrectomy; Oversewing; Oversuturing; Staple line reinforcement; Subclinical hemorrhage; Type 2 diabetes mellitus

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center