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OBES SURG (2008) 18:623630 DOI 10.1007/s11695-007-9297-6
RESEARCH ARTICLE
Management of Anastomotic Leaks After Laparoscopic Roux-en-Y Gastric Bypass
Carlos Ballesta & Ren Berindoague & Marta Cabrera &
Miquel Palau & Magdiel Gonzales
Received: 23 July 2007 /Accepted: 19 August 2007 / Published online: 8 April 2008 # Springer Science + Business Media B.V. 2007
AbstractBackground Anastomotic leaks after bariatric surgery carry high morbidity and mortality. We aimed to describe our experience of the diagnosis and management of gastrointestinal anastomotic leaks in patients undergoing laparoscopic gastric bypass in a single institution.
Methods Of 1,200 patients who underwent laparoscopic Roux-en-Y gastric bypass with manual gastrojejunal anastomosis for morbid obesity from January 2002 to January 2007, we retrospectively analyzed 59 patients with anastomotic leak. The location of the leak, day of diagnosis, diagnostic methods, clinical manifestations, treatment modalities, associated complications, and length of hospital stay were analyzed.
Results Leaks were located as follows: 67.8% in the gastrojejunostomy, 10.2% in the gastric pouch, 3.4% in the excluded stomach, 5.1% in the jejunojejunal anastomosis, 3.4% in the gastrojejunostomy plus pouch, 3.4% in the pouch plus excluded stomach, and 6.8% in undetermined sites. Routine upper gastrointestinal series revealed contrast extravasation in nine patients (15.3%). Leaks were asymptomatic at diagnosis in 29 patients (49.2%). Surgical reintervention was carried out in 23 patients, and conservative treatment was provided in the remaining 36. Transfer to the intensive care unit was required in 11 patients, with five deaths (0.4%).
Conclusion In our experience, most anastomotic leaks can be managed with conservative measures alone. In many patients, abdominal drains are effective in the management of leaks, obviating the need for reintervention. Nasoenteral nutrition was effective in the non-operative management of gastrojejunal leaks in patients without signs of systemic toxicity.
Keywords Morbid obesity. Gastric bypass . Laparoscopy. Complications . Anastomotic leak . Laparoscopic Roux-en-Y gastric bypass . Bariatric surgery
Introduction
Although surgery offers the only effective long-term weight loss therapy for the morbidly obese, operative complications in these patients can be severe and life threatening. Anastomotic leaks are the most dreaded and potentially devastating complication of this type of surgery and carry high morbidity and mortality. The incidence of this complication after Roux-en-Y gastric bypass (RYGBP) ranges from 0 to 5.2% in large series and does not...