Incidence and treatment of leak at the gastrojejunostomy in Roux-en-Y gastric bypass: a cohort study of 40,844 patients

Vidarsson, Bjarni; Sundbom, Magnus; Edholm, David

doi:10.1016/j.soard.2019.04.033

Cited by 25 publications

(16 citation statements)

References 22 publications

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“…In a systematic review and meta-analysis of .100,000 patients undergoing bariatric surgery during 2003 to 2014 in the United States, the mortality rate after leakage and pulmonary embolism was .12% and .18%, respectively [26]. Although the cause of death in one fifth of the present patients was leakage, the incidence of leakages at the gastrojejunostomy was ,1% in an earlier SOReg report of .40,000 gastric bypasses [27]. In contrast to Hollenbeak et al [28], we could not identify hospital volume as a risk factor, again probably due to our low mortality rate of .06%, compared with the 1.15% in the paper by Hollenbeak et al [28].…”

Section: Early Mortalitymentioning

confidence: 53%

Low overall mortality during 10 years of bariatric surgery: nationwide study on 63,469 procedures from the Scandinavian Obesity Registry

Sundbom

Näslund

Vidarsson

et al. 2020

Surgery for Obesity and Related Diseases

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Section: Early Mortalitymentioning

confidence: 53%

Low overall mortality during 10 years of bariatric surgery: nationwide study on 63,469 procedures from the Scandinavian Obesity Registry

Sundbom

Näslund

Vidarsson

et al. 2020

Surgery for Obesity and Related Diseases

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“…Studies on employing endoscopic stenting for GL treatment in bariatric surgery report healing rates of 80-100%. However, such approaches come with risk of stent migration, insufficient leak sealing, persistent peritonitis, and dysphagia [6][7][8][9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic vacuum therapy in salvage and standalone treatment of gastric leaks after bariatric surgery

Markus

Henrik

Reichert

et al. 2021

Langenbecks Arch Surg

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Introduction Gastric leaks constitute some of the most severe complications after obesity surgery. Resulting peritonitis can lead to inflammatory changes of the stomach wall and might necessitate drainage. The inflammatory changes make gastric leak treatment difficult. A common endoscopic approach of using stents causes the problem of inadequate leak sealing and the need for an external drainage. Based on promising results using endoscopic vacuum therapy (EVT) for esophageal leaks, we implemented this concept for gastric leak treatment after bariatric surgery (Ahrens et al., Endoscopy 42(9):693–698, 2010; Schniewind et al., Surg Endosc 27(10):3883–3890, 2013). Methods We retrospectively analyzed data of 31 gastric leaks after bariatric surgery. For leak therapy management, we used revisional laparoscopy with suturing and drainage. EVT was added for persistent leaks in sixteen cases and was used in four cases as standalone therapy. Results Twenty-one gastric leaks occurred in 521 sleeve gastrectomies (leakage rate 4.0%), 9 in 441 Roux-en-Y gastric bypasses (leakage rate 2.3%), and 1 in 12 mini-bypasses. Eleven of these gastric leaks were detected within 2 days after bariatric surgery and successfully treated by revision surgery. Sixteen gastric leaks, re-operated later than 2 days, remained after revision surgery, and EVT was added. Without revision surgery, we performed EVT as standalone therapy in 4 patients with late gastric leaks. The EVT healing rate was 90% (18 of 20). In 2 patients with a late gastric leak in sleeve gastrectomy, neither revisional surgery, EVT, nor stent therapy was successful. EVT patients showed no complications related to EVT during follow-up. Conclusion EVT is highly beneficial in cases of gastric leaks in obesity surgery where local peritonitis is present. Revisional surgery was unsuccessful later than 2 days after primary surgery (16 of 16 cases). EVT shows a similar healing rate to stent therapy (80–100%) but a shorter duration of treatment. The advantages of EVT are endoscopic access, internal drainage, rapid granulation, and direct therapy control. In compartmentalized gastric leaks, EVT was successful as a standalone therapy without external drainage.

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“…40 There are 3 commonly proposed revision operations: fistulojejunostomy, conversion from SG to RYGB (without gastrectomy), and total or near-total gastrectomy with esophagojejunal anastomosis. [41][42][43] Direct surgical repair of the chronic leak site is rarely effective and not advised.…”

Section: Functional Stenosis Precipitating and Propagating Leaks: Best Practice Advicementioning

confidence: 99%

AGA Clinical Practice Update on Evaluation and Management of Early Complications After Bariatric/Metabolic Surgery: Expert Review

Kumbhari

Cummings

Kalloo³

et al. 2021

Clinical Gastroenterology and Hepatology

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Endoscopic techniques are paramount in the identification and management of complications after surgery, though collaboration with other specialties is obligatory. Unfortunately, the evaluation and treatment algorithms are not standardized and there is a paucity of high-quality prospective studies to provide clarity regarding the best approach. The purpose of this clinical practice update is to apprise the clinician with respect to the endoscopic evaluation and management of patients with early (<90 days) complications after undergoing bariatric/ metabolic surgery. METHODS:The recommendations outlined in this expert review are based on available published evidence, including observational studies and systematic reviews, and incorporates expert opinion where applicable.

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Incidence and treatment of leak at the gastrojejunostomy in Roux-en-Y gastric bypass: a cohort study of 40,844 patients

Cited by 25 publications

References 22 publications

Low overall mortality during 10 years of bariatric surgery: nationwide study on 63,469 procedures from the Scandinavian Obesity Registry

Low overall mortality during 10 years of bariatric surgery: nationwide study on 63,469 procedures from the Scandinavian Obesity Registry

Endoscopic vacuum therapy in salvage and standalone treatment of gastric leaks after bariatric surgery

AGA Clinical Practice Update on Evaluation and Management of Early Complications After Bariatric/Metabolic Surgery: Expert Review

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