Advanced

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

Jacobsen, Hedin; Nergård, Bent-Johnny; Leifson, Björn-Geir; Agajahni, Ebrahim; Frederiksen, Sven; Ekelund, Mikael LU ; Hedenbro, Jan LU and Gislason, Hjörtur (2015) In British Journal of Surgery 101(4). p.417-423
Abstract
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... (More)
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. (Less)
Please use this url to cite or link to this publication:
author
publishing date
type
Contribution to journal
publication status
published
subject
in
British Journal of Surgery
volume
101
issue
4
pages
417 - 423
publisher
John Wiley & Sons
external identifiers
  • Scopus:84894101906
ISSN
1365-2168
DOI
10.1002/bjs.9388
language
English
LU publication?
no
id
0dfe8e31-9d85-48ba-bb75-d0807404d594 (old id 7374111)
alternative location
http://dx.doi.org/10.1002/bjs.9388
date added to LUP
2015-06-22 14:17:01
date last changed
2016-11-13 04:32:59
@misc{0dfe8e31-9d85-48ba-bb75-d0807404d594,
  abstract     = {Background<br/><br>
<br/><br>
<br/><br>
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.<br/><br>
<br/><br>
<br/><br>
Methods<br/><br>
<br/><br>
<br/><br>
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.<br/><br>
<br/><br>
<br/><br>
Results<br/><br>
<br/><br>
<br/><br>
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 &lt; 0·001).<br/><br>
<br/><br>
<br/><br>
Conclusion<br/><br>
<br/><br>
<br/><br>
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.},
  author       = {Jacobsen, Hedin and Nergård, Bent-Johnny and Leifson, Björn-Geir and Agajahni, Ebrahim and Frederiksen, Sven and Ekelund, Mikael and Hedenbro, Jan and Gislason, Hjörtur},
  issn         = {1365-2168},
  language     = {eng},
  number       = {4},
  pages        = {417--423},
  publisher    = {ARRAY(0x9b60608)},
  series       = {British Journal of Surgery},
  title        = {Management of suspected anastomotic leak after bariatric laparoscopic Roux-en-y gastric bypass},
  url          = {http://dx.doi.org/10.1002/bjs.9388},
  volume       = {101},
  year         = {2015},
}