LEAKAGE IN BARIATRIC SURGERY: A 10-YEAR EXPERIENCE

Background: Leakage is a dreaded complication of bariatric surgery. The aim of this study was to describe the clinical presentation and outcomes of treatment in patients who develop gastrointestinal leaks after bariatric surgery. 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 average time to diagnosis was 3.9±2.6 days. Six leaks occurred after laparoscopic vertical banded gastroplasty (6.3%), 2 after laparoscopic gastric bypass (3.6%), one after open gastric bypass (2.3%), and 1 after laparoscopic sleeve gastrectomy (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: Leakage is a serious complication after bariatric surgery with a significant mortality. 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