Management of gastrointestinal leaks after surgery for clinically severe obesity |
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| Authors: | Charalambos Spyropoulos Maria-Ioanna Argentou Theodoros Petsas Konstantinos Thomopoulos Ioannis Kehagias Fotis Kalfarentzos |
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| Affiliation: | 1. Department of Surgery, University Hospital of Patras, Rion, Greece;2. Nutrition Support and Morbid Obesity Unit, University Hospital of Patras, Rion, Greece;3. Department of Radiology, University Hospital of Patras, Rion, Greece;4. Department of Internal Medicine, Division of Gastroenterology, University Hospital of Patras, Rion, Greece;1. Value Partnerships Program, Blue Cross and Blue Shield of Michigan, and the Center for Healthcare Outcomes and Policy and Department of Surgery, University of Michigan, Ann Arbor, Michigan;2. Department of Surgery, St. John Providence Health System, St. Clair Shores, Michigan;3. Department of Surgery, Henry Ford Health System, Detroit, Michigan;4. Department of Surgery, Marquette General Hospital, Marquette, Michigan;5. Department of Surgery, Detroit Medical Center, Detroit, Michigan;1. Madigan Army Medical Center, Tacoma, Washington;2. Swedish Medical Center, Seattle, Washington;3. San Antonio Military Medical Center, San Antonio, Texas;4. Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;5. Naval Medical Center San Diego, San Diego, California;6. William Beaumont Army Medical Center, El Paso, Texas;7. Eisenhower Army Medical Center, Fort Gordon, Georgia;8. Tripler Army Medical Center, Honolulu, Hawaii;1. Department of Surgery, University of California, Irvine, Irvine, CA;2. Department of Statistics, University of California, Irvine, Irvine, CA;1. Department of Surgery, University Hospitals Case Medical Center, Case Western Reserve School of Medicine, Cleveland, OH, USA;2. Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve School of Medicine, Cleveland, OH, USA;3. Department of Radiology, The Brooklyn Hospital Center, Weill Cornel Medical College, New York, NY, USA;1. Legacy Good Samaritan Medical Center, Portland, Oregon;2. Boehringer Ingelheim, Ridgefield, Connecticut;3. University of Pittsburgh, Pittsburgh, Pennsylvania;4. Department of Surgery, East Carolina University School of Medicine, Greenville, North Carolina;5. University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;6. Cornell University, New York, New York;7. Department of Surgery, University of Washington, Seattle, Washington;8. Neuropsychiatric Research Institute, Fargo, North Dakota;9. National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland;10. Oregon Health and Science University, Portland, Oregon |
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| Abstract: | BackgroundGastrointestinal leaks after bariatric surgery are the primary cause of serious morbidity and mortality nationwide. Enteric leaks can differ in severity, presentation, and management, depending on the type of bariatric surgery performed. Our objective was to describe the clinical presentation and treatment outcomes in patients who developed postoperative leaks at a university hospital bariatric referral center.MethodsA retrospective observational study using descriptive statistics was conducted on data from 1499 bariatric operations performed at our institution from 1994 to 2010. The procedures included a variant of biliopancreatic diversion with long limb reconstruction (BPD-LL) in 820 patients (791 open and 29 laparoscopic), Roux-en-Y gastric bypass (RYGB) in 301 patients (105 open and 196 laparoscopic), and sleeve gastrectomy (SG) in 208 patients (5 open and 203 laparoscopic).ResultsOf these patients, 30 (2%) developed a postoperative leak at a median of 18 days (range 2–32) postoperatively. The primary procedure was laparoscopic SG in 12 patients (5.8%), laparoscopic RYGB in 5 patients (1.6%), and BPD-LL (12 open and 1 laparoscopic) in 13 patients (1.6%). In all patients who underwent laparoscopic SG, the leak site was along the staple line. The gastrojejunal anastomosis was leaking in 4 (80%) and 12 (92.3%) patients in the RYGB and BPD-LL group, respectively. The enteroenteral anastomosis was leaking in 1 patient each in the RYGB and BPD-LL groups (20% and 7.7%, respectively). Three patients (10%; 2 from the BPD-LL group and 1 from the RYGB group) presented with generalized peritonitis and underwent emergency re-exploration; nonoperative treatment was successful in the remaining 27 patients (90%). Stent placement for persistent gastrocutaneous fistula was used in 9 patients (30%; 8 from the SG cohort and 1 from the BPD-LL group). The overall mortality rate was 3.3%.ConclusionIn our experience, most leaks resulting from antiobesity surgery were successfully managed using nonoperative methods. Rapid management of gastrointestinal leaks using computed tomography-guided drainage and/or intraluminal stent placement could be the treatment of choice in selected patients. |
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