Management of Leak in the Bariatric Gastric Bypass Patient: Reoperate, Drain and Feed Distally

Excerpt

Obesity is recognized as an epidemic in industrialized nations including the USA. It is well known that up to 30% of the adult population in the USA is obese.1 Roux-en-Y gastric bypass has proven to be a reliable and durable treatment for obesity, with medical management being mostly ineffective.2 Roux-en-Y gastric bypass has gained popularity since its inception in the 1960s. Laparoscopic gastric bypass (LRYGB) is a safe procedure in comparison to open gastric bypass (ORYGB) and has been shown by multiple authors to reduce major wound complications including wound infection and incisional hernia.3 Of the complications of gastric bypass, leak may be the most devastating. Leak after gastric bypass is associated with a high morbidity and mortality. The overall incidence of leak after gastric bypass ranges between 2% and 5%, with the gastrojejunal (GJ) anastomosis being the most common site.1 Management strategy of leak after gastric bypass is a topic of much discussion in the bariatric literature. For surgeons performing this procedure, it is important to understand how to manage this complication. …