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J. Stephen Marshall, MD; Anil Srivastava, MD; Samir K. Gupta, MD; Thomas R. Rossi, MD; James R. DeBord, MD

Arch Surg. 2003;138:520-524.

Hypothesis  Enteric leakage is a significant complication of the Roux-en-Y gastric bypass (RYGB) procedure that can be treated successfully.

Design  Retrospective study of 400 consecutive RYGB patients from 1999-2002.

Setting  Community hospital with a university surgical residency.

Patients  Hospital records of 400 morbidly obese patients who underwent gastric bypass surgery were reviewed.

Main Outcome Measures  Time of discovery of leak, location of leak, treatment, hospital stay, and mortality.

Results  Twenty-one patients (5.25%) developed leaks. The mean body mass index (calculated as weight in kilograms divided by the square of height in meters) was 54.2. Thirteen patients were noted to develop a leak at the gastrojejunal anastomosis, with an average time to diagnosis of 7.0 days. Five of these patients underwent reexploration, and 8 were successfully treated with percutaneous drainage alone. Four patients developed leaks at the jejunojejunal anastomosis (mean time to diagnosis, 2.0 days). All of these patients required exploration, and 2 patients died. Four patients were noted to have leaks in other areas (average time to diagnosis, 3.5 days). Two patients were treated with drainage, and 2 underwent exploration. The average hospital stay of all patients was 33 days.

Conclusions  Enteric leakage is a significant complication of the RYGB. Patients who are suspected of having an enteric leak because of signs of sepsis or hemodynamic instability require emergent exploration. Leaks that are more insidious may be treated successfully with percutaneous drainage. Aggressive exploration of patients who appear to be septic, and percutaneous drainage of insidiously developing leaks may decrease patients' morbidity and mortality.

From the Department of Surgery, University of Illinois College of Medicine–Peoria (Drs Marshall, Srivastava, Gupta, Rossi, and DeBord), and the Peoria Surgical Group Ltd (Drs Marshall, Gupta, Rossi, and DeBord), Peoria, Ill.

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