BS O06 - Management of Leaks post Bariatric Surgery: Recent Experience from a Tertiary Bariatric Surgery Referral Unit

Abstract

Abstract Background Bariatric surgery has been consistently demonstrated to provide effective long-term sustained weight loss and remission of several life-threatening conditions. The most common bariatric procedures undertaken globally include laparoscopic sleeve gastrectomy (SG) and gastric bypass2. These procedures are safe and have low associated mortality rates [0.05% SG, 0.09% single anastomosis gastric bypass (SAGB) and Roux-en-Y (RNYGB)]3. However, complications including staple line and anastomotic leaks can occur in up to 3% of patients and are associated with significant morbidity, thus requiring prompt identification and treatment4. Our study aims to analyse management of these leaks and establish an algorithm for our centre. Method This was a retrospective study of consecutive patients who experienced post-bariatric surgery leak between 2018 to 2024, in a regional tertiary bariatric surgery referral unit in the UK, serving a population of 5 million. The study included patients who underwent bariatric surgery in the UK or abroad (SG, RNYGB and SAGB), both primary and revision cases, and were subsequently diagnosed with post-operative leak. Patients were initially managed in our facility or referred to our centre for ongoing management of leak from other centres. Demographics, time to presentation, hospital length of stay (LOS), diagnostic investigations performed, and management approaches were analysed. Results 22 patients (8 bypasses, 14 sleeves) were included. Mean time to presentation from index surgery was 19.6 days and mean LOS was 43.6 days. Initial management included conservative (3), endo-vacuum therapy (EVT) (4), stent (1), surgical (14) [9 laparoscopy and 5 laparotomy]. Surgical management comprised 7 T-tube insertions, 1 Foley catheter, 2 primary repairs, 2 EVTs, 1 washout and drain, and 1 stoma formation. Three patients required no further intervention, six needed different management approaches and three required re-operations. 7 patients were readmitted following discharge. Resolution of leak was achieved in all cases. There was no 90-day mortality. Conclusion Management of postoperative leak following bariatric surgery is a complex issue, requiring early identification, adequate drainage and control of sepsis, and maintenance of nutrition. Successful management requires a proactive and aggressive approach, including early clinical suspicion. Access to a range of interventions to support a dynamic approach to management is critical. The sequence and choice of management of leaks should be individualised according to each patient’s clinical presentation and investigation findings. A combination of different management approaches is often required for successful treatment of leak. Multicentre studies are needed to move closer to a consensus on managing bariatric leaks.