Earliest signs and management of leakage after bariatric surgeries: Single institute experience

Abstract

Background: The aim of this study was to describe the clinical presentation and outcomes of treatment in patients who develop gastrointestinal leaks after different bariatric surgeries.
Methods: Retrospective review of 632 consecutive bariatric surgical procedures performed from 1999–2009 in Alexandria University Hospital, Egypt.
Results: Leakage occurred in 10 patients. Symptoms and signs included tachycardia, fever, tachypnea, left shoulder pain, abdominal pain, chest pain, and/or change in the nature of the drain effluent. The earliest signs of presentation were tachycardia and unilateral decrease in air entry in all patients. The average time to diagnosis was 3.9± 2.6 days. In four patients contrast study was negative (40%). Six leaks occurred after laparoscopic sleeve gastrectomy (6.3%), 2 after laparoscopic gastric bypass (3.6%), one after open gastric bypass (2.3%), and 1 after laparoscopic vertical banded gastroplasty (2.4%). The most common leak location was at the esophagogastric junction (70%). Four patients (40%) required reoperations. A percutaneous abdominal drainage was placed in five patients (50%). In 2 patients (20%), the prophylactic drain was maintained in situ till cessation of leakage. Two patients (20%) died. Mean hospital length of stay was 13.9 ± 7.8 days.
Conclusions: Tachycardia and unequal breath sound in the early postoperative course are worrisome signs that warrant laparoscopic exploration even if contrast studies were negative. Patients with signs of sepsis or hemodynamic instability require emergent exploration. Leaks that are more insidious may be treated successfully with percutaneous drainage or maintenance of prophylactic drains.

Keywords: Morbid obesity; Bariatric surgery; Complication; Leak