Abstract
Laparoscopic bariatric procedures offer effective treatments for medically complicated obesity, and as experience grows in this surgical specialty and also due to the success of the Fellowships overseen by the Fellowship Council, complications are becoming remarkably rare. The vast majority of patients undergoing a bariatric procedure can expect minimal postoperative pain, a hospital stay of less than 48 h, and dramatic weight loss with improvement in obesity-related comorbid diseases within the first year. Despite the complexity of these procedures coupled with the technical challenges inherent to operating on obese patients, perioperative morbidity and mortality are low. The two most important causes of early postoperative morbidity are pulmonary embolism and enteric leak; in this chapter, we will focus on diagnosis and management of the latter, although it is important to realize that these two complications may mimic one another in terms of signs and symptoms. We will present and dissect a case report illustrating the important principles of postoperative management of this complication. Leaks after bariatric operations are potentially life-threatening, and management of leaks depends largely on the timing and severity of illness at presentation. A high index of suspicion is warranted, because a delay in diagnosis and treatment can very realistically be the difference between a favorable outcome and death.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Aff. 2009;28(5):w822–31.
Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23:427–36.
Lim RB. Bariatric operative procedures: thirty-day morbidity and mortality. UptoDate, Jones DJ, editor. Waltham, MA; 2015.
Hamilton EC, Sims TL, Hamilton TT. Clinical predictors of leak after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc Interv Tech. 2003;17:679–84.
Podnos YD, Jimenez JC, Wilson SE, et al. Complications after laparoscopic gastric bypass: a review of 3464 cases. Arch Surg. 2003;138(9):957–61.
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(1):47–55.
Biertho L, Steffen R, Ricklin T, et al. Laparoscopic gastric bypass versus laparoscopic adjustable gastric banding: a comparative study of 1,200 cases. J Am Coll Surg. 2003;197(4):536–44; Discussion. 544–5.
DeMaria EJ, Sugerman HJ, Kellum JM, 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.
Fernandez AZ Jr, DeMaria EJ, Tichansky DS, et al. Experience with over 3,000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality. Surg Endosc. 2004;18(2):193–7.
Higa KD, Ho T, Boone KB. Laparoscopic Roux-en-Y gastric bypass: technique and 3-year follow-up. J Laparoendosc Adv Surg Tech A. 2001;11(6):377–82.
Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;234(3):279–89; Discussion. 289–91.
Papasavas PK, Hayetian FD, Caushaj PF, et al. Outcome analysis of laparoscopic Roux-en-Y gastric bypass for morbid obesity. The first 116 cases. Surg Endosc. 2002;16(12):1653–7.
Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. 2000;232(4):515–29.
Wittgrove AC, Clark GW. Laparoscopic gastric bypass, Roux-en-Y 500 patients: technique and results, with 3-60 month follow-up. Obes Surg. 2000;10(3):233–9.
Nesset EM, Kendrick ML, Houghton SG, Mai JL, Thompson GB, Que FG, Thomsen KM, Larson DR, Sarr MG. A two-decade spectrum of revisional bariatric surgery at a tertiary referral center. Surg Obes Relat Dis. 2007;3:25–30.
Fernandez Jr AZ, DeMaria EJ, TIchansky DS, et al. Experience with over 3,000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality. Surg Endosc. 2004;(18):193–7.
Podnos YD, Jimenez JC, Wilson SE, et al. Complications after laparoscopic gastric bypass. Arch Surg. 2003;138:957–61.
Lim RB. Bariatric operations: perioperative morbidity and mortality. Uptodate, Jones DJ, editor. Waltham, MA; 2015.
Burgos AM, Braghetto I, Csendes A, et al. Gastric leak after laparoscopic-sleeve gastrectomy for obesity. Obes Surg. 2009;19:1672–7.
Bingham J, Shawhan R, Parker R. Computed tomography scan versus upper gastrointestinal fluoroscopy for diagnosis of staple line leak following bariatric surgery. Am J Surg. 2015;209:810–4.
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 systemic review of the literature. Obes Surg. 2014;24:1096–101.
Schiesser M, Guber J, Wildi S. Utility of routine versus selective upper gastrointestinal series to detect anastomotic leaks after gastric bypass. Obes Surg. 2011;21(8):1238–42.
Bege T, Emungania O, Vitton V, et al. An endoscopic strategy for management of anastomotic complications from bariatric surgery: a prospective study. Gastroint Endosc. 2011;73:238–44.
Puli SR, Spofford IS, Thompson CC. Use of self-expandable stents in the treatment of bariatric surgery leaks: a systemic review and meta-analysis. Clin Endosc. 2012;75(2):287–93.
Puig CA, Waked TM, Baron Sr TH, Wong Kee Song LM, Gutierrez J. The role of endoscopic stents in the management of chronic anastomotic and staple line leaks and chronic strictures after bariatric surgery. Surg Obes Rel Dis. 2014 Jul–Aug;10(4):613–7.
Ritter LA, Wang AY, Sauer BG. Healing of complicated gastric leaks in bariatric patients using endoscopic clips. JSLS. 2013 Jul–Sep;17(3):481–3.
Goenka MK, Goenka U. Endotherapy of leaks and fistula. World J Gastrointest Endosc. 2015;7(7):702–13.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Kellogg, T., Hughes, J., Sada, A., Sarr, M. (2017). Post-bariatric Complications—Leaks. In: Diaz, J., Efron, D. (eds) Complications in Acute Care Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-42376-0_20
Download citation
DOI: https://doi.org/10.1007/978-3-319-42376-0_20
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-42374-6
Online ISBN: 978-3-319-42376-0
eBook Packages: MedicineMedicine (R0)