Esophagojejunostomy or Fistulojejunostomy Are Safe Salvage Operations for Bariatric Surgery Leaks

Abstract

Background: Sleeve gastrectomy is the most commonly performed bariatric surgery, and staple line leaks occur in 1% or less of patients. Gastric bypass is still a common weight loss surgery with a leak rate of 2%. Definitive surgical management of the leak is mainly accomplished with esophagojejunostomy or fistulojejunostomy. Proceeding with surgical management of these leaks is poorly understood given the rare need and high risk. We reviewed our outcomes of definitive surgical management for leaks following weight loss surgery. Methods: An institutional review board approved database identified patients undergoing definitive surgical management for bariatric surgery leaks with either an esophagojejunostomy or fistulojejunostomy. Initial data that led to the leak, intraoperative factors, and postoperative outcomes were collected. Primary endpoint was leak after definitive surgical procedure. Results: A database of 87 patients was queried to find 22 patients undergoing surgery. Twelve patients underwent esophagojejunostomy and 10 patients underwent fistulojejunostomy. There was a mean of 90 days to leak recognition. There was a mean of 228 days from first endoscopic procedure to definitive surgery in the 18 patients undergoing initial endoscopic management. The mean time from the sentinel surgery to definitive surgery was 296 days. There were 6 patients (27%) that had subsequent leaks after definitive surgery. All subsequent leaks healed with endoscopic therapy. No deaths occurred. Conclusion: Bariatric surgery leaks are difficult to manage. When endoscopic management fails, esophagojejunostomy, and fistulojejunostomy are safe and feasible salvage options. Additional leaks following these salvage operations can occur in up to 27% of patients.