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Incidence and treatment of leak at the gastrojejunostomy in Roux-en-Y gastric bypass: a cohort study of 40,844 patients
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.ORCID iD: 0000-0002-6243-2859
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.ORCID iD: 0000-0003-2172-5310
2019 (English)In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 15, no 7, p. 1075-1079Article in journal (Refereed) Published
Abstract [en]

Background: Leak at the gastrojejunostomy (GJ) after Roux-en-Y gastric bypass is a rare but life-threatening complication. Objectives: To assess incidence, risk factors, treatment, and outcome of leaks at the GJ after Roux-en-Y gastric bypass in a nationwide cohort. Setting: Sweden. Methods: Leaks at GJ within 30 days postoperatively in 40,844 patients (age 41 yr, females 76%, and body mass index of 42.4 kg/m(2)) between 2007 and 2014 in the Scandinavian Obesity Surgery Registry were assessed. Register data and outcomes were verified by reviewing patient charts. Logistic regression was done to estimate odds ratios (ORs) for significant risk factors. Results: Leak at the GJ was registered in 262 (.6%) patients, with 44% diagnosed within the first 3 postoperative days. Risk factors were male sex (OR 1.5 [1.1-1.9]), age >= 49 years (OR 1.9 [1.3-2.7]), diabetes (OR 1.4 [1.1-1.9]), conversion to open surgery (OR 3.9 [2.2-6.9]), and operative time >= 90 minutes (OR 2.6 [1.8-3.8]). In most patients, the leak resulted in a severe complication. Reoperative surgery was done in 85%, with the placement of a feeding gastrostomy in 24%. Stents were used at some time point in 31% of leaks. Of all patients with leaks, 25% required intensive care, 4% developed multiorgan failure, and 1% died. Median duration of stay for patients with leaks was 22 days, versus 2 days for others (P < .001). Conclusion: GJ leaks occurred in .6% of patients. Risk factors were male sex, age >= 49 years, diabetes, operative time >= 90 minutes, and conversion to open surgery. Surgical reintervention was common. Mortality was 1%. (C) 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC , 2019. Vol. 15, no 7, p. 1075-1079
Keywords [en]
Complications, RYGB, Gastric bypass, Leaks, Reoperation
National Category
Gastroenterology and Hepatology Surgery
Identifiers
URN: urn:nbn:se:uu:diva-394171DOI: 10.1016/j.soard.2019.04.033ISI: 000483453000006PubMedID: 31201112OAI: oai:DiVA.org:uu-394171DiVA, id: diva2:1358669
Available from: 2019-10-08 Created: 2019-10-08 Last updated: 2019-10-08Bibliographically approved

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Vidarsson, BjarniSundbom, MagnusEdholm, David

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