This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Management of suspected anastomotic leak after bariatric laparoscopic Roux‐en‐y gastric bypass. BJS 2014; 101: 417-423.

Published: 17th February 2014

Authors: H. J. Jacobsen, B. J. Nergard, B. G. Leifsson, S. G. Frederiksen, E. Agajahni, M. Ekelund et al.

Background

Anastomotic leak is one of the most serious complications following bariatric laparoscopic Roux‐en‐Y gastric bypass (LRYGB), and associated with high morbidity rates and prolonged hospital stay. Timely management is of utmost importance for the clinical outcome. This study evaluated the approach to suspected leakage in a high‐volume bariatric surgery unit.

Method

All consecutive patients who underwent LRYGB performed by the same team of surgeons were registered prospectively in a clinical database from September 2005 to June 2012. Suspected leaks were identified based on either clinical suspicion and/or associated laboratory values, or by a complication severity grade of at least II using the Clavien–Dindo score.

Results

A total of 6030 patients underwent LRYGB during the study period. The leakage rate was 1·1 per cent (64 patients). Forty‐five leaks (70 per cent) were treated surgically and 19 (30 per cent) conservatively. Eight (13 per cent) of 64 patients needed intensive care and the mortality rate was 3 per cent (2 of 64). Early leaks (developing in 5 days or fewer after LRYGB) were treated by suture of the defect in 20 of 22 patients and/or operative drainage in 13. Late leaks (after 5 days) were managed with operative drainage in 19 of 23 patients and insertion of a gastrostomy tube in 15. Patients who underwent surgical treatment early after the symptoms of leakage developed had a shorter hospital stay than those who had symptoms for more than 24 h before reoperation (12·5 versus 24·4 days respectively; P < 0·001).

Conclusion

Clinical suspicion of an anastomotic leak should prompt an aggressive surgical approach without undue delay. Early operative treatment was associated with shorter hospital stay. Delays in treatment, including patient delay, after symptom development were associated with adverse outcomes.

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Management of suspected anastomotic leak after bariatric laparoscopic Roux‐en‐y gastric bypass. BJS 2014; 101: 417-423.

Background

Method

Results

Conclusion

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Quality of life from a randomized trial of laparoscopic or open liver resection for colorectal liver metastases. BJS 2019; 106: 1372-1380.

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