title: 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.affiliation: Legacy Good Samaritan Medical Center, Portland, Oregon. Electronic address: mdsmith2@mac.com.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Smith
authors.affiliation: Boehringer Ingelheim, Ridgefield, Connecticut.
authors.forename: Abidemi
authors.initials: A
authors.lastname: Adeniji
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Abdus S
authors.initials: AS
authors.lastname: Wahed
authors.affiliation: Legacy Good Samaritan Medical Center, Portland, Oregon.
authors.forename: Emma
authors.initials: E
authors.lastname: Patterson
authors.affiliation: Department of Surgery, East Carolina University School of Medicine, Greenville, North Carolina.
authors.forename: William
authors.initials: W
authors.lastname: Chapman
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Anita P
authors.initials: AP
authors.lastname: Courcoulas
authors.affiliation: Cornell University, New York, New York.
authors.forename: Gregory
authors.initials: G
authors.lastname: Dakin
authors.affiliation: Department of Surgery, University of Washington, Seattle, Washington.
authors.forename: David
authors.initials: D
authors.lastname: Flum
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Carol
authors.initials: C
authors.lastname: McCloskey
authors.affiliation: Neuropsychiatric Research Institute, Fargo, North Dakota.
authors.forename: James E
authors.initials: JE
authors.lastname: Mitchell
authors.affiliation: Cornell University, New York, New York.
authors.forename: Alfons
authors.initials: A
authors.lastname: Pomp
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.
authors.forename: Myrlene
authors.initials: M
authors.lastname: Staten
authors.affiliation: Oregon Health and Science University, Portland, Oregon.
authors.forename: Bruce
authors.initials: B
authors.lastname: Wolfe
mesh_terms: D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012086:Reoperation; D014014:Tissue Adhesives / Q000627:therapeutic use*; D014481:United States / Q000453:epidemiology
chemical_list: D014014:Tissue Adhesives
keywords: Anastomotic leak; Roux-en-Y gastric bypass; Technical factors