title: Classification and management of leaks after gastric bypass for patients with morbid obesity: a prospective study of 60 patients.
abstract: The most important and frequent major complication after gastric bypass is the appearance of a leak, which can result in death of a patient. The purpose of this prospective study was to determine the incidence of a postoperative leak, to propose a classification and to evaluate the results of conservative or surgical treatment. All patients submitted to gastric bypass either laparotomic or laparoscopic were included in a prospective protocol. In all radiological evaluation at 4(th) day after surgery was performed. The presence of a leak was evaluated according to the day of appearance, its location and its severity. Results of medical or surgical treatment were analyzed. From 1764 patients submitted to Roux-en-Y gastric bypass, 60 had a postoperative leak (3.4%). This leak appeared early after surgery (before 4 days) in 20%. It was a localized subclinical leak in 20% and clinical - septic in 80%. There were 7 possible anatomic location of a leak, being the gastrojejunal anastomosis the most frequent location (53%) followed by gastric pouch. The highest mortality was associated to the jejuno-jejunal anastomosis. Conservative treatment was employed in near 65% of the patients: The mean time of closure of a leak was 34 days. The appearance of a postoperative leak is a major and serious complication. It can be classified according to the day of appearance, its severity and its location. Conservative or surgical treatment can be employed properly if these 3 parameters are carefully evaluated.
authors.affiliation: Department of Surgery, Hospital J.J. Aguirre, University Hospital, Santos Dumont 999, Santiago, Chile. acsendes@redclinicauchile.cl
authors.forename: Attila
authors.initials: A
authors.lastname: Csendes
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Burgos
authors.forename: Italo
authors.initials: I
authors.lastname: Braghetto
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D057868:Anastomotic Leak / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D007583:Jejunum / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008751:Methylene Blue; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011446:Prospective Studies; D011859:Radiography; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008751:Methylene Blue