Technical factors associated with anastomotic leak after Roux-en-Y gastric bypass.

Abstract

BACKGROUND:

Anastomotic leak is one of the most serious complications after Roux-en-Y gastric bypass (RYGB). Our objective was to examine the relationship between technical factors and incidence of clinically relevant anastomotic leak after RYGB in longitudinal assessment of bariatric surgery (LABS). The setting of the study was 11 bariatric centers in the United States, university, and private practice.

METHODS:

Patient characteristics, technical factors of surgery, and postoperative outcomes were assessed by trained researchers using standardized protocols. Correlation of surgical factors of patients undergoing RYGB (n = 4444) with the incidence of postoperative anastomotic leak was assessed by univariate χ(2) analysis.

RESULTS:

Forty-four participants (1.0%, 95% CI .7%-1.3%) experienced a clinically relevant anastomotic leak. Of these, 39 (89%) underwent abdominal reoperation and 3 (7%) died. Technical factors associated with anastomotic leak were open surgery (P<.0001), revision surgery (P<.0001), and use of an abdominal drain (P = .02). Provocative leak testing, method of gastrojejunostomy, and use of fibrin sealant were not associated with anastomotic leak.

CONCLUSIONS:

Anastomotic leak after RYGB was rare (1.0%). Most cases required reintervention; however, the majority (93%) recovered from this event. Open surgery, revision surgery, and routine drain placement were associated with increased leak rate. Some of these findings may be due to differences in preoperative patient risk.

• Authors: Mark D Smith, Abidemi Adeniji, Abdus S Wahed, Emma Patterson, William Chapman, Anita P Courcoulas, Gregory Dakin, David Flum, Carol McCloskey, James E Mitchell, Alfons Pomp, Myrlene Staten, Bruce Wolfe
• Journal: Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery (Surg Obes Relat Dis) 2015 Mar-Apr Vol. 11 Issue 2 Pg. 313-20 ISSN: 1878-7533 [Electronic] United States
• PMID: 25595919 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2015 American Society for Metabolic and Bariatric Surgery. All rights reserved.

Chemical References

• Tissue Adhesives

Topics

• Adult
• Aged
• Anastomotic Leak (epidemiology, surgery)
• Female
• Gastric Bypass (adverse effects)
• Humans
• Incidence
• Laparoscopy (methods)
• Male
• Middle Aged
• Obesity, Morbid (surgery)
• Reoperation
• Tissue Adhesives (therapeutic use)
• United States (epidemiology)