Management of Leaks After Gastric Bypass
Praveen Raj Palanivelu and Saravana Kumar
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 % . Although not so commonly debated like a sleeve leak, it still represents a major and serious bariatric surgical complication with high mortality rates . 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 .
P.R. Palanivelu, MS, DNB, DNB(SGE), FALS, FMAS (*)
S. Kumar, DNB (Gen. Surgery), MS, FMAS
© Springer Nature Singapore Pte Ltd. 2017
P.R. Palanivelu et al. (eds.), Bariatric Surgical Practice Guide,
Severity of Leak
Based on the severity, leaks can be classified as, Type I-localized
Type II-clinically significant leak
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