Abstract
Anastomotic leak represents a serious complication of gastric bypass carrying significant morbidity and mortality for the bariatric patient, frequently leading to prolonged hospital stay, additional diagnostic tests, and increased risk for surgical reintervention. Leaks may develop in approximately 5% of patients following gastric bypass as a result of mechanical and/or ischemic factors disrupting the normal healing process of a suture or staple line. This chapter describes the classification and clinical presentation of leaks, as well as the key features for prevention, early diagnosis, and management. Bariatric surgery is an effective therapeutic option for morbid obesity. The prompt identification and management of its related complications are essential to improving clinical practice and surgical outcomes.
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References
Obesity and Overweight: fact sheet. World Health Organization; 2016.
Angrisani L, et al. Bariatric surgery and endoluminal procedures: IFSO Worldwide Survey 2014. Obes Surg. 2017;27:2279–89.
Berbiglia L, Zografakis JG, Dan AG. Laparoscopic Roux-en-Y gastric bypass: surgical technique and perioperative care. Surg Clin North Am. 2016;96(4):773–94.
Nguyen NT, Rivers R, Wolfe BM. Factors associated with operative outcomes in laparoscopic gastric bypass. J Am Coll Surg. 2003;197(4):548–55.
Afaneh C, Dakin GF. Enteric leaks after gastric bypass: prevention and management, in bariatric surgery complications and emergencies. In: Herron DM, editor. Springer, Switzerland 2016. p. 81–9.
Csendes A, Burgos AM, Braghetto I. Classification and management of leaks after gastric bypass for patients with morbid obesity: a prospective study of 60 patients. Obes Surg. 2012;22(6):855–62.
Brethauer SC, Chand B, Schauer P. Risks and benefits of bariatric surgery: current evidence. Cleve Clin J Med. 2006;73:993.
Genser L, et al. Presentation and surgical management of leaks after mini-gastric bypass for morbid obesity. Surg Obes Relat Dis. 2016;12(2):305–12.
Jacobsen HJ, et al. Management of suspected anastomotic leak after bariatric laparoscopic Roux-en-y gastric bypass. Br J Surg. 2014;101(4):417–23.
Quartararo G, et al. Upper gastrointestinal series after Roux-en-Y gastric bypass for morbid obesity: effectiveness in leakage detection. A systematic review of the literature. Obes Surg. 2014;24(7):1096–101.
Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis. 2009;5(4):469–75.
Mickevicius A, Sufi P, Heath D. Factors predicting the occurrence of a gastrojejunal anastomosis leak following gastric bypass. Wideochir Inne Tech Maloinwazyjne. 2014;9(3):436–40.
Kim J, et al. ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management. Surg Obes Relat Dis. 2015;11(4):739–48.
Varban OA, et al. Technique or technology? Evaluating leaks after gastric bypass. Surg Obes Relat Dis. 2016;12(2):264–72.
Livingston EH, Huerta S, Arthur D, Lee S, De Shields S, Heber D. Male gender is a predictor of morbidity and age a predictor of mortality for patients undergoing gastric bypass surgery. Ann Surg. 2002;236:576.
Arteaga-Gonzalez I, et al. Usefulness of clinical signs and diagnostic tests for suspected leaks in bariatric surgery. Obes Surg. 2015;25(9):1680–4.
El-Kadre L, et al. Overcoming the learning curve of laparoscopic Roux-en-Y gastric bypass: a 12-year experience. Surg Obes Relat Dis. 2013;9(6):867–72.
Schauer P, et al. The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases. Surg Endosc. 2003;17(2):212–5.
DeMaria EJ, et al. Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg. 2002;235(5):640–5. discussion 645–7
Brethauer SA. Sleeve gastrectomy. Surg Clin North Am. 2011;91(6):1265–79. ix
Kolakowski S, Kirkland M, Schuricht A. Routine postoperative upper gastrointestinal series after Roux-en-Y gastric bypass: determination of whether it is necessary. Arch Surg. 2007;142(10):930–4.
Guerron AD, Portenier DD. Patient selection and surgical management of high-risk patients with morbid obesity. Surg Clin North Am. 2016;96(4):743–62.
Gonzalez R, et al. Diagnosis and contemporary management of anastomotic leaks after gastric bypass for obesity. J Am Coll Surg. 2007;204(1):47–55.
Schiesser M, et al. Successful endoscopic management of gastrointestinal leakages after laparoscopic Roux-en-Y gastric bypass surgery. Dig Surg. 2014;31(1):67–70.
Joo MK. Endoscopic approach for major complications of bariatric surgery. Clin Endosc. 2017;50(1):31–41.
Chang J, et al. Endoscopic stents in the management of anastomotic complications after foregut surgery: new applications and techniques. Surg Obes Relat Dis. 2016;12(7):1373–81.
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Guerron, A.D., Ortega, C.B., Portenier, D. (2018). Anastomotic Leak Following Gastric Bypass. In: Camacho, D., Zundel, N. (eds) Complications in Bariatric Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-75841-1_6
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DOI: https://doi.org/10.1007/978-3-319-75841-1_6
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