Diagnosis and Contemporary Management of Anastomotic Leaks after Gastric Bypass for Obesity

Rodrigo Gonzalez, Michael G. Sarr, C. Daniel Smith, Mercedeh Baghai, Michael Kendrick, Samuel Szomstein, Raul Rosenthal, Michel M. Murr

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)47-55
Number of pages9
JournalJournal of the American College of Surgeons
Volume204
Issue number1
DOIs
StatePublished - Jan 2007

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Anastomotic Leak
Gastric Bypass
Obesity
Stomach
Morbidity
Oliguria
Bariatric Surgery
Mortality
Reoperation
Tertiary Care Centers
Tachycardia
Hypotension
Abdominal Pain
Signs and Symptoms
Drainage
Fever
Therapeutics
Hemodynamics

ASJC Scopus subject areas

  • Surgery

Cite this

Gonzalez, R., Sarr, M. G., Smith, C. D., Baghai, M., Kendrick, M., Szomstein, S., ... Murr, M. M. (2007). Diagnosis and Contemporary Management of Anastomotic Leaks after Gastric Bypass for Obesity. Journal of the American College of Surgeons, 204(1), 47-55. https://doi.org/10.1016/j.jamcollsurg.2006.09.023

Diagnosis and Contemporary Management of Anastomotic Leaks after Gastric Bypass for Obesity. / Gonzalez, Rodrigo; Sarr, Michael G.; Smith, C. Daniel; Baghai, Mercedeh; Kendrick, Michael; Szomstein, Samuel; Rosenthal, Raul; Murr, Michel M.

In: Journal of the American College of Surgeons, Vol. 204, No. 1, 01.2007, p. 47-55.

Research output: Contribution to journalArticle

Gonzalez, R, Sarr, MG, Smith, CD, Baghai, M, Kendrick, M, Szomstein, S, Rosenthal, R & Murr, MM 2007, 'Diagnosis and Contemporary Management of Anastomotic Leaks after Gastric Bypass for Obesity', Journal of the American College of Surgeons, vol. 204, no. 1, pp. 47-55. https://doi.org/10.1016/j.jamcollsurg.2006.09.023
Gonzalez, Rodrigo ; Sarr, Michael G. ; Smith, C. Daniel ; Baghai, Mercedeh ; Kendrick, Michael ; Szomstein, Samuel ; Rosenthal, Raul ; Murr, Michel M. / Diagnosis and Contemporary Management of Anastomotic Leaks after Gastric Bypass for Obesity. In: Journal of the American College of Surgeons. 2007 ; Vol. 204, No. 1. pp. 47-55.
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