Skip to main content
SpringerLink
Log in

Anastomotic Leak After Bariatric Surgery: Prevention and Treatment

  • Chapter
Emergency Surgery in Obese Patients

Part of the book series: Updates in Surgery ((UPDATESSURG))

  • 516 Accesses

Abstract

Anastomotic leak is one of the most challenging complications of bariatric surgery. It is rare but causes a significant risk of death to the patient and requires a strong resource engagement and a multidisciplinary approach of treatment. Our aim is to analyze the main factors involved in leak development for each bariatric operation and the most useful strategies to prevent and to treat this complication.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Norgard NB, Monte SV. Obesity and inflammation and altered clopidogrel pharmacokinetics and pharmacodynamics. Drug Metab Lett. 2017;11:3–13.

    CAS  PubMed  Google Scholar 

  2. Bastard JP, Maachi M, Lagathu C, et al. Recent advances in the relationship between obesity, inflammation, and insulin resistance. Eur Cytokine Netw. 2006;17:4–12.

    CAS  PubMed  Google Scholar 

  3. Boutagy NE, McMillan RP, Frisard MI, Hulver MW. Metabolic endotoxemia with obesity: is it real and is it relevant? Biochimie. 2016;124:11–20.

    CAS  PubMed  Google Scholar 

  4. Hutter MM, Schirmer BD, Jones DB, et al. First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg. 2011;254:410–20; discussion 420–2.

    PubMed  Google Scholar 

  5. Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26:1509–15.

    PubMed  Google Scholar 

  6. Kim J, Azagury D, Eisenberg D, et al.; American Society for Metabolic and Bariatric Surgery Clinical Issues Committee. 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;11:739–48.

    Google Scholar 

  7. Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, Arvidsson D, Baker RS, et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8:8–19.

    Google Scholar 

  8. Deitel M, Gagner M, Erickson AL, Crosby RD. Third International Summit: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2011;7:749–59.

    PubMed  Google Scholar 

  9. Yuval JB, Mintz Y, Cohen MJ, et al. The effects of bougie caliber on leaks and excess weight loss following laparoscopic sleeve gastrectomy. Is there an ideal bougie size? Obes Surg. 2013;23:1685–91.

    PubMed  Google Scholar 

  10. Parikh M, Issa R, McCrillis A, et al. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg. 2013;257:231–7.

    PubMed  Google Scholar 

  11. Nienhuijs SW, Kaymak U, Korsten E, Buise MP. Influence of intraoperative hypotension on leaks after sleeve gastrectomy. Surg Obes Relat Dis. 2016;12:535–9.

    PubMed  Google Scholar 

  12. Berger ER, Clements RH, Morton JM, et al. The impact of different surgical techniques on outcomes in laparoscopic sleeve gastrectomies: the first report from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). Ann Surg. 2016;264:464–73.

    PubMed  Google Scholar 

  13. Chen B, Kiriakopoulos A, Tsakayannis D, et al. Reinforcement does not necessarily reduce the rate of staple line leaks after sleeve gastrectomy. A review of the literature and clinical experiences. Obes Surg. 2009;19:166–72.

    PubMed  Google Scholar 

  14. Dapri G, Cadière GB, Himpens J. Reinforcing the staple line during laparoscopic sleeve gastrectomy: prospective randomized clinical study comparing three different techniques. Obes Surg. 2010;20:462–7.

    PubMed  Google Scholar 

  15. Musella M, Milone M, Maietta P, et al. Laparoscopic sleeve gastrectomy: efficacy of fibrin sealant in reducing postoperative bleeding. A randomized controlled trial. Updates Surg. 2014;66:197–201.

    PubMed  Google Scholar 

  16. Choi YY, Bae J, Hur KY, et al. Reinforcing the staple line during laparoscopic sleeve gastrectomy: does it have advantages? A meta-analysis. Obes Surg. 2012;22:1206–13.

    PubMed  Google Scholar 

  17. Wang Z, Dai X, Xie H, et al. The efficacy of staple line reinforcement during laparoscopic sleeve gastrectomy: a meta-analysis of randomized controlled trials. Int J Surg. 2016;25:145–52.

    PubMed  Google Scholar 

  18. Ortega CB, Guerron AD, Yoo JS. The use of fluorescence angiography during laparoscopic sleeve gastrectomy. JSLS. 2018;22:e2018.00005. https://doi.org/10.4293/JSLS.2018.00005.

  19. Gnecchi M, Bella G, Pino AR, et al. Usefulness of x-ray in the detection of complications and side effects after laparoscopic sleeve gastrectomy. Obes Surg. 2013;23:456–9.

    CAS  PubMed  Google Scholar 

  20. Alban EAD, García CA, Ospina LM, Munevar HE. Imaging after bariatric surgery: when interpretation is a challenge, from normal to abnormal. Obes Surg. 2018;28:2923–31.

    PubMed  Google Scholar 

  21. Moon RC, Teixeira AF, Bezerra L, et al. Management of bariatric complications using endoscopic stents: a multi-center study. Obes Surg. 2018;28:4034–8.

    PubMed  Google Scholar 

  22. Shoar S, Poliakin L, Khorgami Z, et al. Efficacy and safety of the over-the-scope clip (OTSC) system in the management of leak and fistula after laparoscopic sleeve gastrectomy: a systematic review. Obes Surg. 2017;27:2410–8.

    PubMed  Google Scholar 

  23. Gonzalez R, Nelson LG, Gallagher SF, Murr MM. Anastomotic leaks after laparoscopic gastric bypass. Obes Surg. 2004;14:1299–307.

    PubMed  Google Scholar 

  24. Al-Kurd A, Grinbaum R, Abubeih A, et al. Not all leaks are created equal: a comparison between leaks after sleeve gastrectomy and Roux-en-Y gastric bypass. Obes Surg. 2018;28:3775–82.

    PubMed  Google Scholar 

  25. Kumar SB, Hamilton BC, Wood SG, et al. Is laparoscopic sleeve gastrectomy safer than laparoscopic gastric bypass? A comparison of 30-day complications using the MBSAQIP data registry. Surg Obes Relat Dis. 2018;14:264–9.

    PubMed  Google Scholar 

  26. Janik MR, Mustafa RR, Rogula TG, et al. Safety of laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass in elderly patients—analysis of the MBSAQIP. Surg Obes Relat Dis. 2018;14:1276–82.

    PubMed  Google Scholar 

  27. Shikora SA. The use of staple-line reinforcement during laparoscopic gastric bypass. Obes Surg. 2004;14:1313–20.

    PubMed  Google Scholar 

  28. Nandakumar G, Richards BG, Trencheva K, Dakin G. Surgical adhesive increases burst pressure and seals leaks in stapled gastrojejunostomy. Surg Obes Relat Dis. 2010;6:498–501.

    PubMed  Google Scholar 

  29. Sajid MS, Khatri K, Singh K, Sayegh M. Use of staple-line reinforcement in laparoscopic gastric bypass surgery: a meta-analysis. Surg Endosc. 2011;25:2884–91.

    CAS  PubMed  Google Scholar 

  30. Shikora SA, Mahoney CB. Clinical benefit of gastric staple line reinforcement (SLR) in gastrointestinal surgery: a meta-analysis. Obes Surg. 2015;25:1133–41.

    PubMed  PubMed Central  Google Scholar 

  31. Valenzuela-Salazar C, Rojano-Rodríguez ME, Romero-Loera S, et al. Intraoperative endoscopy prevents technical defect related leaks in laparoscopic Roux-en-Y gastric bypass: a randomized control trial. Int J Surg. 2018;50:17–21.

    PubMed  Google Scholar 

  32. Leslie DB, Dorman RB, Anderson J, et al. Routine upper gastrointestinal imaging is superior to clinical signs for detecting gastrojejunal leak after laparoscopic Roux-en-Y gastric bypass. J Am Coll Surg. 2012;214:208–13.

    PubMed  Google Scholar 

  33. Quartararo G, Facchiano E, Scaringi S, 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;24:1096–101.

    PubMed  Google Scholar 

  34. Durak E, Inabnet WB, Schrope B, et al. Incidence and management of enteric leaks after gastric bypass for morbid obesity during a 10-year period. Surg Obes Relat Dis. 2008;4:389–93.

    PubMed  Google Scholar 

  35. Jacobsen HJ, Nergard BJ, Leifsson BG, et al. Management of suspected anastomotic leak after bariatric laparoscopic Roux-en-Y gastric bypass. Br J Surg. 2014;101:417–23.

    CAS  PubMed  PubMed Central  Google Scholar 

  36. Gonzalez R, Sarr MG, Smith CD, et al. Diagnosis and contemporary management of anastomotic leaks after gastric bypass for obesity. J Am Coll Surg. 2007;204:47–55.

    PubMed  Google Scholar 

  37. Okazaki O, Bernardo WM, Brunaldi VO, et al. Efficacy and safety of stents in the treatment of fistula after bariatric surgery: a systematic review and meta-analysis. Obes Surg. 2018;28:1788–96.

    PubMed  Google Scholar 

  38. De Luca M, Tie T, Ooi G, et al. Mini gastric bypass-one anastomosis gastric bypass (MGB-OAGB)—IFSO Position Statement. Obes Surg. 2018;28:1188–206.

    PubMed  Google Scholar 

  39. Parmar CD, Mahawar KK. One anastomosis (mini) gastric bypass is now an established bariatric procedure: a systematic review of 12,807 patients. Obes Surg. 2018;28:2956–67.

    PubMed  Google Scholar 

  40. Mahawar KK, Himpens J, Shikora SA, et al. The first consensus statement on one anastomosis/mini gastric bypass (OAGB/MGB) using a modified Delphi approach. Obes Surg. 2018;28:303–12.

    PubMed  Google Scholar 

  41. Georgiadou D, Sergentanis TN, Nixon A, et al. Efficacy and safety of laparoscopic mini gastric bypass. A systematic review. Surg Obes Relat Dis. 2014;10:984–91.

    PubMed  Google Scholar 

  42. Genser L, Carandina S, Tabbara M, et al. Presentation and surgical management of leaks after mini-gastric bypass for morbid obesity. Surg Obes Relat Dis. 2016;12:305–12.

    PubMed  Google Scholar 

  43. Silecchia G, Iossa A. Complications of staple line and anastomoses following laparoscopic bariatric surgery. Ann Gastroenterol. 2018;31:56–64.

    PubMed  Google Scholar 

  44. Beaupel N, Bruzzi M, Voron T, et al. Management of acute intra-abdominal sepsis caused by leakage after one anastomosis gastric bypass. Surg Obes Relat Dis. 2017;13:1297–305.

    PubMed  Google Scholar 

  45. Buchwald H, Oien D. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23:427–36.

    PubMed  Google Scholar 

  46. Biertho L, Simon-Hould F, Marceau S, et al. Current outcomes of laparoscopic duodenal switch. Ann Surg Innov Res. 2016;10:1. https://doi.org/10.1186/s13022-016-0024-7.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Nguyen NT, Paya P, Stevens CM, et al. The relationship between hospital volume and outcome in bariatric surgery at academic medical centers. Ann Surg. 2004;240:586–93; discussion 593–4.

    PubMed  PubMed Central  Google Scholar 

  48. Silecchia G, Rizzello M, Abbatini F. Duodenal switch. In: Angrisani L, De Luca M, Formisano G, Santonicola A, editors. Bariatric and metabolic surgery. Indications, complications and revisional procedures. Berlin: Springer; 2017. p. 93–105.

    Google Scholar 

  49. Biertho L, Lebel S, Marceau S, et al. Perioperative complications in a consecutive series of 1000 duodenal switches. Surg Obes Relat Dis. 2013;9:63–8.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Castelfranco and Montebelluna Hospitals, Treviso, Italy

    Maurizio De Luca, Giacomo Piatto, Cesare Lunardi, Alberto Sartori, Nicola Clemente & Natale Pellicanò

Authors
  1. Maurizio De Luca
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giacomo Piatto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cesare Lunardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alberto Sartori
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nicola Clemente
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Natale Pellicanò
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maurizio De Luca .

Editor information

Editors and Affiliations

  1. Department of Biomedical Sciences Luigi Sacco, University of Milan, Milan, Italy

    Diego Foschi

  2. Department of Human Pathology of Adult and Evolutive Age, University of Messina, Messina, Italy

    Giuseppe Navarra

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Cite this chapter

De Luca, M., Piatto, G., Lunardi, C., Sartori, A., Clemente, N., Pellicanò, N. (2020). Anastomotic Leak After Bariatric Surgery: Prevention and Treatment. In: Foschi, D., Navarra, G. (eds) Emergency Surgery in Obese Patients. Updates in Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-17305-0_22

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-17305-0_22

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-17304-3

  • Online ISBN: 978-3-030-17305-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation