TY - JOUR
T1 - Technical factors associated with anastomotic leak after Roux-en-Y gastric bypass
AU - Smith, Mark D.
AU - Adeniji, Abidemi
AU - Wahed, Abdus S.
AU - Patterson, Emma
AU - Chapman, William
AU - Courcoulas, Anita P.
AU - Dakin, Gregory
AU - Flum, David
AU - McCloskey, Carol
AU - Mitchell, James E.
AU - Pomp, Alfons
AU - Staten, Myrlene
AU - Wolfe, Bruce
N1 - Publisher Copyright:
© 2015 American Society for Metabolic and Bariatric Surgery.
PY - 2015/3/1
Y1 - 2015/3/1
N2 - Background Anastomotic leak is one of the most serious complications after Roux-en-Y gastric bypass (RYGB). Our objective was to examine the relationship between technical factors and incidence of clinically relevant anastomotic leak after RYGB in longitudinal assessment of bariatric surgery (LABS). The setting of the study was 11 bariatric centers in the United States, university, and private practice. Methods Patient characteristics, technical factors of surgery, and postoperative outcomes were assessed by trained researchers using standardized protocols. Correlation of surgical factors of patients undergoing RYGB (n = 4444) with the incidence of postoperative anastomotic leak was assessed by univariate χ2 analysis. Results Forty-four participants (1.0%, 95% CI.7%-1.3%) experienced a clinically relevant anastomotic leak. Of these, 39 (89%) underwent abdominal reoperation and 3 (7%) died. Technical factors associated with anastomotic leak were open surgery (P<.0001), revision surgery (P<.0001), and use of an abdominal drain (P =.02). Provocative leak testing, method of gastrojejunostomy, and use of fibrin sealant were not associated with anastomotic leak. Conclusions Anastomotic leak after RYGB was rare (1.0%). Most cases required reintervention; however, the majority (93%) recovered from this event. Open surgery, revision surgery, and routine drain placement were associated with increased leak rate. Some of these findings may be due to differences in preoperative patient risk.
AB - Background Anastomotic leak is one of the most serious complications after Roux-en-Y gastric bypass (RYGB). Our objective was to examine the relationship between technical factors and incidence of clinically relevant anastomotic leak after RYGB in longitudinal assessment of bariatric surgery (LABS). The setting of the study was 11 bariatric centers in the United States, university, and private practice. Methods Patient characteristics, technical factors of surgery, and postoperative outcomes were assessed by trained researchers using standardized protocols. Correlation of surgical factors of patients undergoing RYGB (n = 4444) with the incidence of postoperative anastomotic leak was assessed by univariate χ2 analysis. Results Forty-four participants (1.0%, 95% CI.7%-1.3%) experienced a clinically relevant anastomotic leak. Of these, 39 (89%) underwent abdominal reoperation and 3 (7%) died. Technical factors associated with anastomotic leak were open surgery (P<.0001), revision surgery (P<.0001), and use of an abdominal drain (P =.02). Provocative leak testing, method of gastrojejunostomy, and use of fibrin sealant were not associated with anastomotic leak. Conclusions Anastomotic leak after RYGB was rare (1.0%). Most cases required reintervention; however, the majority (93%) recovered from this event. Open surgery, revision surgery, and routine drain placement were associated with increased leak rate. Some of these findings may be due to differences in preoperative patient risk.
KW - Anastomotic leak
KW - Roux-en-Y gastric bypass
KW - Technical factors
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U2 - 10.1016/j.soard.2014.05.036
DO - 10.1016/j.soard.2014.05.036
M3 - Article
C2 - 25595919
AN - SCOPUS:84929503314
SN - 1550-7289
VL - 11
SP - 313
EP - 320
JO - Surgery for Obesity and Related Diseases
JF - Surgery for Obesity and Related Diseases
IS - 2
ER -