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Jan Hedenbro

Jan Hedenbro

Visiting research fellow

Jan Hedenbro

Management of suspected anastomotic leak after bariatric laparoscopic Roux-en-y gastric bypass

Author

  • Hedin Jacobsen
  • Bent-Johnny Nergård
  • Björn-Geir Leifson
  • Ebrahim Agajahni
  • Sven Frederiksen
  • Mikael Ekelund
  • Jan Hedenbro
  • Hjörtur Gislason

Summary, in English

Background





Anastomotic leak is one of the most serious complications following bariatric laparoscopic Roux-en-Y gastric bypass (LRYGB), and associated with high morbidity rates and prolonged hospital stay. Timely management is of utmost importance for the clinical outcome. This study evaluated the approach to suspected leakage in a high-volume bariatric surgery unit.





Methods





All consecutive patients who underwent LRYGB performed by the same team of surgeons were registered prospectively in a clinical database from September 2005 to June 2012. Suspected leaks were identified based on either clinical suspicion and/or associated laboratory values, or by a complication severity grade of at least II using the Clavien–Dindo score.





Results





A total of 6030 patients underwent LRYGB during the study period. The leakage rate was 1·1 per cent (64 patients). Forty-five leaks (70 per cent) were treated surgically and 19 (30 per cent) conservatively. Eight (13 per cent) of 64 patients needed intensive care and the mortality rate was 3 per cent (2 of 64). Early leaks (developing in 5 days or fewer after LRYGB) were treated by suture of the defect in 20 of 22 patients and/or operative drainage in 13. Late leaks (after 5 days) were managed with operative drainage in 19 of 23 patients and insertion of a gastrostomy tube in 15. Patients who underwent surgical treatment early after the symptoms of leakage developed had a shorter hospital stay than those who had symptoms for more than 24 h before reoperation (12·5 versus 24·4 days respectively; P < 0·001).





Conclusion





Clinical suspicion of an anastomotic leak should prompt an aggressive surgical approach without undue delay. Early operative treatment was associated with shorter hospital stay. Delays in treatment, including patient delay, after symptom development were associated with adverse outcomes.

Publishing year

2015

Language

English

Pages

417-423

Publication/Series

British Journal of Surgery

Volume

101

Issue

4

Document type

Journal article

Publisher

Oxford University Press

Topic

  • Gastroenterology and Hepatology
  • Surgery

Status

Published

ISBN/ISSN/Other

  • ISSN: 1365-2168