Management of Gastrointestinal Leaks and Fistula

  • Ninh T. Nguyen
  • Shaun C. DalyEmail author


Bariatric operations involving gastrointestinal resection and/or reconstruction can be associated with gastrointestinal leaks and fistula. Common bariatric operations that can lead to development of gastrointestinal leaks include Roux-en-Y gastric bypass, sleeve gastrectomy, and the duodenal switch operation. Expeditious recognition and early institution of management for gastrointestinal leaks are keys to minimize the progression from systemic inflammatory response to eventual sepsis. Prompt management of gastrointestinal leak can also minimize the risk for development of a chronic fistula, which is often difficult to treat. This chapter reviews the etiologies of gastrointestinal leaks, common presenting signs and symptoms, diagnostic evaluation, and management of acute gastrointestinal leaks and chronic fistula.


Sepsis Gastrointestinal leak Ischemia Toxicity Washout Stent 


  1. 1.
    Khorgami Z, Shoar S, Andalib A, Aminian A, Brethauer SA, Schauer PR. Trends in utilization of bariatric surgery, 2010–2014: sleeve gastrectomy dominates. Surg Obes Relat Dis. 2017;13(5):774–8.CrossRefGoogle Scholar
  2. 2.
    Clinical Issues Committee of the American Society for Metabolic and Bariatric Surgery. Updated position statement on the prevention and detection of gastrointestinal leak. May 2015.Google Scholar
  3. 3.
    Yehoshua RT, Eidelman LA, Stein M, Fichman S, Mazor A, Chen J, et al. Laparoscopic sleeve gastrectomy–volume and pressure assessment. Obes Surg. 2008;18(9):1083–8.CrossRefGoogle Scholar
  4. 4.
    Hamilton EC, Sims TL, Hamilton TT, Mullican MA, Jones DB, Provost DA. Clinical predictors of leak after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc. 2003;17(5):679–84.CrossRefGoogle Scholar
  5. 5.
    Warschkow R, Tarantino I, Folie P, Beutner U, Schmied BM, Bisang P, et al. C-reactive protein 2 days after laparoscopic gastric bypass surgery reliably indicates leaks and moderately predicts morbidity. J Gastrointest Surg. 2012;16(6):1128–35.CrossRefGoogle Scholar
  6. 6.
    Nguyen NT, Nguyen X-MT, Dholakia C. The use of endoscopic stent in management of leaks after sleeve gastrectomy. Obes Surg. 2010;20(9):1289–92.CrossRefGoogle Scholar
  7. 7.
    Serra C, Baltasar A, Andreo L, Pérez N, Bou R, Bengochea M, et al. Treatment of gastric leaks with coated self-expanding stents after sleeve gastrectomy. Obes Surg. 2007;17(7):866–72.CrossRefGoogle Scholar
  8. 8.
    Simon F, Siciliano I, Gillet A, Castel B, Coffin B, Msika S. Gastric leak after laparoscopic sleeve gastrectomy: early covered self-expandable stent reduces healing time. Obes Surg. 2013;23:687–92.CrossRefGoogle Scholar
  9. 9.
    Oshiro T, Kasama K, Umezawa A, Kanehira E, Kurokawa Y. Successful management of refractory staple line leakage at the esophagogastric junction after a sleeve gastrectomy using the HANAROSTENT. Obes Surg. 2010;20(4):530–4.CrossRefGoogle Scholar
  10. 10.
    Tan JT, Kariyawasam S, Wijeratne T, Chandraratna HS. Diagnosis and management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg. 2010;20(4):403–9.CrossRefGoogle Scholar
  11. 11.
    Sakran N, Goitein D, Raziel A, Keidar A, Beglaibter N, Grinbaum R, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2013;27(1):240–5.CrossRefGoogle Scholar
  12. 12.
    Sakran N, Assalia A, Keidar A, Goitein D. Gastrobronchial fistula as a complication of bariatric surgery: a series of 6 cases. Obes Facts. 2012;5(4):538–45.CrossRefGoogle Scholar
  13. 13.
    Gonzalez R, Sarr MG, Smith CD, Baghai M, Kendrick M, Szomstein S, et al. Diagnosis and contemporary management of anastomotic leaks after gastric bypass for obesity. J Am Coll Surg. 2007;204(1):47–55.CrossRefGoogle Scholar
  14. 14.
    Gonzalez R, Nelson LG, Gallagher SF, Murr MM. Anastomotic leaks after laparoscopic gastric bypass. Obes Surg. 2004;14(10):1299–307.CrossRefGoogle Scholar
  15. 15.
    Nguyen NT, Rudersdorf PD, Smith BR, Reavis K, Nguyen X-MT, Stamos MJ. Management of gastrointestinal leaks after minimally invasive esophagectomy: conventional treatments vs. endoscopic stenting. J Gastrointest Surg. 2011;15(11):1952–60.CrossRefGoogle Scholar
  16. 16.
    Casella G, Soricelli E, Rizzello M, Trentino P, Fiocca F, Fantini A, et al. Nonsurgical treatment of staple line leaks after laparoscopic sleeve gastrectomy. Obes Surg. 2009;19(7):821–6.CrossRefGoogle Scholar
  17. 17.
    El Mourad H, Himpens J, Verhofstadt J. Stent treatment for fistula after obesity surgery: results in 47 consecutive patients. Surg Endosc. 2013;27:808–16.CrossRefGoogle Scholar
  18. 18.
    de Aretxabala X, Leon J, Wiedmaier G, Turu I, Ovalle C, Maluenda F, et al. Gastric leak after sleeve gastrectomy: analysis of its management. Obes Surg. 2011;21(8):1232–7.CrossRefGoogle Scholar
  19. 19.
    Csendes A, Braghetto I, León P, Burgos AM. Management of leaks after laparoscopic sleeve gastrectomy in patients with obesity. J Gastrointest Surg. 2010;14(9):1343–8.CrossRefGoogle Scholar
  20. 20.
    Freedman J, Jonas E, Näslund E, Nilsson H, Marsk R, Stockeld D. Treatment of leaking gastrojejunostomy after gastric bypass surgery with special emphasis on stenting. Surg Obes Relat Dis. 2013;9(4):554–8. in pressGoogle Scholar
  21. 21.
    Thodiyil PA, Yenumula P, Rogula T, Gorecki P, Fahoum B, Gourash W, et al. Selective nonoperative management of leaks after gastric bypass: lessons learned from 2675 consecutive patients. Ann Surg. 2008;248(5):782–92.CrossRefGoogle Scholar
  22. 22.
    Ballesta C, Berindoague R, Cabrera M, Palau M, Gonzales M. Management of anastomotic leaks after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18(6):623–30.CrossRefGoogle Scholar
  23. 23.
    Spyropoulos C, Argentou M-I, Petsas T, Thomopoulos K, Kehagias I, Kalfarentzos F. Management of gastrointestinal leaks after surgery for clinically severe obesity. Surg Obes Relat Dis. 2012;8(5):609–15.CrossRefGoogle Scholar
  24. 24.
    Eisendrath P, Cremer M, Himpens J, Cadière G-B, Le Moine O, Devière J. Endotherapy including temporary stenting of fistulas of the upper gastrointestinal tract after laparoscopic bariatric surgery. Endoscopy. 2007;39(7):625–30.CrossRefGoogle Scholar
  25. 25.
    Eubanks S, Edwards CA, Fearing NM, Ramaswamy A, la Torre de RA, Thaler KJ, et al. Use of endoscopic stents to treat anastomotic complications after bariatric surgery. J Am Coll Surg. 2008;206(5):935–8.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Surgery, Division of Gastrointestinal SurgeryUniversity of California, Irvine Medical CenterOrangeUSA

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