Management of Leaks After Gastric Bypass

Praveen Raj Palanivelu and Saravana Kumar

Introduction

The incidence of leaks after roux en Y gastric bypass (RYGB) is not uncommon and has been reported to be between 0 and 5.6 % with a mean of 2.6 % [1]. Although not so commonly debated like a sleeve leak, it still represents a major and serious bariatric surgical complication with high mortality rates [2]. Leak related mortality rates of 37.5-50 % has been reported and along with pulmonary embolism is an important cause of mortality [3-5].

Classification of Leaks

The presence of leak after any kind of gastric bypass can be classified based on three parameters as suggested by Csendes et al. [6-8].

Time of Appearance After Surgery

Early -1-4 days Intermediate-5-9 days Late-10 or more days.

Jacobsen et al. proposes an alternate classification with those within 5 days as early and more than 5 days as late leaks, as those leaks within 5 days are usually related to technical aspects of the surgery and anything after with a more complex etiology [9].

P.R. Palanivelu, MS, DNB, DNB(SGE), FALS, FMAS (*)

S. Kumar, DNB (Gen. Surgery), MS, FMAS

Bariatric Division, Upper Gastrointestinal Surgery and Minimal Access Surgery Unit, GEM Hospital and Research Centre, Coimbatore, India e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it ; This email address is being protected from spam bots, you need Javascript enabled to view it

P.R. Palanivelu et al. (eds.), Bariatric Surgical Practice Guide,

DOI 10.1007/978-981-10-2705-5_27

Severity of Leak

Based on the severity, leaks can be classified as, Type I-localized

Type II-clinically significant leak

Location

Based on the site of leak, they can be classifies as follows:

Type 1-Gastric pouch

Type 2-Gastrojejunal (GJ) anastamosis

Type 3-Jejunal stump

Type 4-Jejunojejunal (JJ) anastomosis

Type 5-Excluded stomach

Type 6-Duodenal stump in resectional bypass

Type 7-Blind end jejunal limb