title: [Anastomosis and suture insufficiency after interventions for bariatric and metabolic surgery].
abstract: BACKGROUND
  Metabolic surgery is internationally well-established for the treatment of obesity and its comorbidities. The numbers of procedures performed is steadily increasing. The results of surgery are superior in comparison to conservative treatment options regarding weight loss and resolution of comorbidities. The insufficiency of suture lines is a well-known and feared complication in the stapling procedures and is associated with an increased morbidity as well as mortality, especially in super obese patients.
  
  
  METHODS
  The current literature was reviewed and the results are reported within the context of own experience.
  
  
  RESULTS
  The most severe complications are staple line leakage after sleeve gastrectomy, leakage of anastomoses after bypass procedures and duodenal stump insufficiency. For the treatment of sleeve leakage various endoscopic procedures, such as over the scope (OTS) clips, stents and endoluminal vacuum therapy are available. Surgical revision, such as oversuturing, drainage and redo surgery are well-established. The management of all other complications is mainly by surgical intervention. Intraoperative standardization of procedures and knowledge of the physical foundations are essential for the prevention of leakage. Several preventive methods are available but randomized controlled trials are missing.
  
  
  CONCLUSIONS
  The therapy of leakages in the field of bariatric surgery is an interdisciplinary approach and dependent on the available resources in the treating hospital. The data reported show good results but the different reports published are inconsistent. Leakages often do not occur in the immediate postoperative period but in the sense of a long-term complication; therefore standardization of procedures and follow-up as well as complication management is mandatory. Randomized controlled studies must be promoted.
authors: Adipositaszentrum, Chirurgische Klinik, Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488, Frankfurt am Main, Deutschland, Weiner.sylvia@KHNW.de.
authors: S
authors: S
authors: Weiner
authors: T
authors: T
authors: Heidsieck
authors: S
authors: S
authors: Chiappetta
authors: C
authors: C
authors: Stier
authors: R A
authors: RA
authors: Weiner
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak / Q000209:etiology / Q000601:surgery*; D050110:Bariatric Surgery; D005500:Follow-Up Studies; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D013528:Surgical Staplers; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000601:surgery*; D013536:Suture Techniques