title: Presentation and surgical management of leaks after mini-gastric bypass for morbid obesity.
abstract: BACKGROUND
  Few data exist about the characteristics and management of enteric leaks after mini-gastric bypass (MGB).
  
  
  OBJECTIVE
  We aimed to describe the incidence, presentation, and surgical management of enteric leaks in patients who underwent laparoscopic MGB for morbid obesity.
  
  
  METHODS
  Private practice.
  
  
  METHODS
  An 8-year, 9-month retrospective chart review was performed on patients who had enteric leak requiring reoperation after MGB at a single institution.
  
  
  RESULTS
  Thirty-five of 2321 patients were included. Ninety-seven percent had symptoms. Arterial hypertension and heavy smoking were predicting factors of leaks occurrence post-MGB (P<.01). Enteric leak was diagnosed by systematic upper gastrointestinal series in 4 pts (11.4%) and by computed tomography with oral water soluble contrast in 4 of 31 pts (13%). In the other 27 patients, diagnosis of the leak was made intraoperatively. Eleven patients (32%) had leak arising from the gastric stapler line (type 1), 4 (11%) from the gastrojejunal anastomosis (type 2), and 20 (57%) from undetermined origin. The most common presentation was intra-abdominal abscess in type 1 and leaks of undetermined origin and generalized peritonitis in type 2. One third of the patients who underwent reoperation developed well-drained chronic fistula into the irrigation-drainage system, with complete healing in all patients without any further procedure. The mean hospital stay was 19 days with no mortality reported.
  
  
  CONCLUSIONS
  Enteric leak leading to intra-abdominal sepsis post-MGB is rare (1.5%) An operative aggressive management based on clinical symptoms is the treatment of choice allowing no postoperative leak-related mortality and complete healing.
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Department of Digestive and Hepato-Pancreato-Biliary Surgery, Pierre & Marie Curie University (Paris VI), Paris, France.. Electronic address: laurent.genser@gmail.com.
authors.forename: Laurent
authors.initials: L
authors.lastname: Genser
authors.affiliation: Department of Digestive and Metabolic Surgery, Jean Verdier Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH "Léonard de Vinci," Bondy, France.
authors.forename: Sergio
authors.initials: S
authors.lastname: Carandina
authors.affiliation: Department of Digestive and Metabolic Surgery, Jean Verdier Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH "Léonard de Vinci," Bondy, France.
authors.forename: Malek
authors.initials: M
authors.lastname: Tabbara
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Department of Digestive and Hepato-Pancreato-Biliary Surgery, Pierre & Marie Curie University (Paris VI), Paris, France.
authors.forename: Adriana
authors.initials: A
authors.lastname: Torcivia
authors.affiliation: Department of Digestive Surgery, Clinique Geoffroy-Saint Hilaire, Générale de Santé (GDS), Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Soprani
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Department of Digestive and Hepato-Pancreato-Biliary Surgery, Pierre & Marie Curie University (Paris VI), Paris, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Siksik
authors.affiliation: Department of Digestive Surgery, Clinique Geoffroy-Saint Hilaire, Générale de Santé (GDS), Paris, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Cady
mesh_terms: D057868:Anastomotic Leak / Q000175:diagnosis / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed
keywords: Complications; Leaks; Mini–gastric bypass; Omega loop gastric bypass