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

  • Arnaud Liagre
  • Michel Queralto
  • Gildas Juglard
  • Yves Anduze
  • Antonio Iannelli
  • Francesco MartiniEmail author
Original Contributions
  • 36 Downloads

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.

Keywords

One-anastomosis gastric bypass Leak Multidisciplinary management Surgical treatment Percutaneous drainage Endoscopic drainage 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Statement of Human and Animal Rights

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.

Statement of Informed Consent

For this type of study formal consent is not required.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Digestive and Bariatric Surgery UnitClinique des CedresCornebarrieuFrance
  2. 2.Gastrointestinal Endoscopy UnitClinique des CedresCornebarrieuFrance
  3. 3.Université Côte d’AzurNiceFrance
  4. 4.Digestive Surgery and Liver Transplantation Unit, Archet 2 HospitalCentre Hospitalier Universitaire de NiceNiceFrance
  5. 5.Inserm, U1065, Team 8 “Hepatic complications of obesity”NiceFrance
  6. 6.Digestive and Bariatric Surgery UnitHôpital Joseph DucuingToulouseFrance

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