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Multidisciplinary Management of Leaks After One-Anastomosis Gastric Bypass in a Single-Center Series of 2780 Consecutive Patients

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Abstract

Purpose

Few data exist in the literature concerning leaks after one-anastomosis gastric bypass (OAGB). Our aim was to describe the incidence, presentation, and management of leaks after OAGB.

Setting

A private clinic in France.

Methods

Between May 2010 and December 2017, 2780 consecutive patients underwent OAGB. A retrospective chart review was performed on the 46 patients (1.7%) who experienced postoperative leaks.

Results

Leaks arose from the anastomosis in 6 cases (13%) and from the gastric pouch in 27 cases (59%), while the remaining 13 patients (28%) had leaks from an undetermined origin. Management followed a standardized algorithm taking into consideration the clinical situation and findings on an oral contrast computed tomography (CT) scan. All patients were treated by fasting, total parenteral nutrition, and antimicrobial therapy. Nine patients (20%) could be managed by medical treatment only, 13 patients (28%) underwent laparoscopic management (washout and drainage plus T-tube placement in 5 cases or conversion to Roux-en-Y gastric bypass (RYGB) in one case). The remaining 23 patients (50%) were managed by percutaneous drainage and/or endoscopy. No mortality was observed; the major morbidity rate was 20%. The median length of a hospital stay was 17 days (5–80).

Conclusion

Management of leaks after OAGB depends on clinical conditions and presence, size, and location of an abscess and/or a fistula. If endoscopy and interventional radiology are available, reoperation can be avoided in most patients. In most leaks at the gastrojejunal anastomosis, inserting a T-tube in the leak orifice avoids the necessity for conversion to RYGB.

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Authors and Affiliations

  1. Digestive and Bariatric Surgery Unit, Clinique des Cedres, Cornebarrieu, France

    Arnaud Liagre, Gildas Juglard & Yves Anduze

  2. Gastrointestinal Endoscopy Unit, Clinique des Cedres, Cornebarrieu, France

    Michel Queralto

  3. Université Côte d’Azur, Nice, France

    Antonio Iannelli

  4. Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Nice, France

    Antonio Iannelli

  5. Inserm, U1065, Team 8 “Hepatic complications of obesity”, Nice, France

    Antonio Iannelli

  6. Digestive and Bariatric Surgery Unit, Hôpital Joseph Ducuing, 15 Rue Varsovie, 31027, Toulouse, France

    Francesco Martini

Authors
  1. Arnaud Liagre
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  2. Michel Queralto
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  3. Gildas Juglard
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  4. Yves Anduze
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  5. Antonio Iannelli
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  6. Francesco Martini
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Corresponding author

Correspondence to Francesco Martini.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Liagre, A., Queralto, M., Juglard, G. et al. Multidisciplinary Management of Leaks After One-Anastomosis Gastric Bypass in a Single-Center Series of 2780 Consecutive Patients. OBES SURG 29, 1452–1461 (2019). https://doi.org/10.1007/s11695-019-03754-2

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  • DOI: https://doi.org/10.1007/s11695-019-03754-2

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