2% of patients developed anastomotic leaks after Roux-en-Y gastric bypass.

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2% of patients developed anastomotic leaks after Roux-en-Y gastric bypass.

J Am Coll Surg. 2007 Jan;204(1):47-55. Epub 2006 Nov 17.Click here to read

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Diagnosis and contemporary management of anastomotic leaks after gastric

bypass for obesity.

* R,

Interdisciplinary Obesity Treatment Group, Department of Surgery,

University of South Florida Health Sciences Center, Tampa, FL 33601, USA.

BACKGROUND:

Anastomotic leaks are a dreaded complication of bariatric surgery.

The objective of this study was to describe the clinical presentation and

outcomes of treatment in patients who develop anastomotic leaks after

Roux-en-Y gastric bypass for obesity.

STUDY DESIGN: Prospectively collected data on 3,018 consecutive patients who

underwent Roux-en-Y gastric bypass in 4 tertiary referral centers were

reviewed.

RESULTS:

Sixty-three patients **(2.1%)** developed anastomotic leaks

(open, 2.1%; laparoscopic, 2.1%)

at a median of 3 days (range 0 to 28 days)

after Roux-en-Y gastric bypass.

Symptoms and signs included

tachycardia (72%),

fever (63%), or

abdominal pain (54%).

Upper gastrointestinal series and CT demonstrated leaks in only 17 of 56

(30%) and 28 of 50 (56%) patients, respectively; when done jointly, both

studies were negative in 30% of patients.

The 68 anastomotic leaks occurred at the gastrojejunostomy (49%), excluded

stomach (25%), jejunojejunostomy (13%), gastric pouch (9%), and uncertain

location (4%).

Forty patients (63%) required 58 reoperations for drainage of intraabdominal

collections (55%), repair of anastomotic defects (34%), or revision of the

leaking anastomosis (11%), with an overall morbidity of 53% and mortality of

10%.

Nonoperative treatment was successful in 23 of 26 patients, with an overall

morbidity of 61% and no mortality (p=NS versus operative).

Operative treatment was more common in patients with hypotension or oliguria

(p < 0.01).

CONCLUSIONS: Lack of specificity in clinical presentation and imaging

studies make diagnosing anastomotic leaks challenging, so operative

exploration should be part of the diagnostic algorithm.

Nonoperative treatment is safe and effective in a subset of patients who

exhibit stable hemodynamic parameters and are known to have controlled

leaks.