Skip to main content

Post-bariatric Complications—Leaks

  • Chapter
  • First Online:
Complications in Acute Care Surgery
  • 1279 Accesses

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.

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

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover 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. 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.

    Article  Google Scholar 

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

    Article  PubMed  Google Scholar 

  3. Lim RB. Bariatric operative procedures: thirty-day morbidity and mortality. UptoDate, Jones DJ, editor. Waltham, MA; 2015.

    Google Scholar 

  4. 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.

    Article  CAS  Google Scholar 

  5. 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.

    Article  PubMed  Google Scholar 

  6. 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.

    Article  PubMed  Google Scholar 

  7. 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.

    Google Scholar 

  8. 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.

    Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  CAS  PubMed  Google Scholar 

  11. 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.

    Google Scholar 

  12. 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.

    Article  CAS  PubMed  Google Scholar 

  13. Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. 2000;232(4):515–29.

    CAS  Google Scholar 

  14. 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.

    Article  CAS  PubMed  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. 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.

    Google Scholar 

  17. Podnos YD, Jimenez JC, Wilson SE, et al. Complications after laparoscopic gastric bypass. Arch Surg. 2003;138:957–61.

    Article  PubMed  Google Scholar 

  18. Lim RB. Bariatric operations: perioperative morbidity and mortality. Uptodate, Jones DJ, editor. Waltham, MA; 2015.

    Google Scholar 

  19. Burgos AM, Braghetto I, Csendes A, et al. Gastric leak after laparoscopic-sleeve gastrectomy for obesity. Obes Surg. 2009;19:1672–7.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  PubMed  Google Scholar 

  21. 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.

    Article  PubMed  Google Scholar 

  22. 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.

    Article  PubMed  Google Scholar 

  23. 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.

    Article  Google Scholar 

  24. 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.

    Google Scholar 

  25. 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.

    Google Scholar 

  26. 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.

    Google Scholar 

  27. Goenka MK, Goenka U. Endotherapy of leaks and fistula. World J Gastrointest Endosc. 2015;7(7):702–13.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Todd Kellogg .

Editor information

Editors and Affiliations

Rights and permissions

Reprints 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)

Publish with us

Policies and ethics