Management of Postgastric Bypass Jejuno-jejunal Anastomotic Leak: A Multicenter Retrospective Study

Abstract

Abstract Introduction: Anastomotic leakage is one of the most critical complications following gastric bypass surgery. Leakage from jejuno-jejunal (JJ) anastomosis after Roux-en-Y gastric bypass occurs infrequently, and so there are fewer studies on its management. The JJ anastomotic leak (AL) has high morbidity and mortality; hence, early detection and timely management are critical to optimizing outcomes. Aims and Objectives: We evaluated all the treatment options for the patients experiencing JJ anastomosis leaks to propose an algorithm-based practical management guideline for these patients. Materials and Methods: During the early postoperative period, retrospective analysis using clinical findings, blood parameters, and contrast computed tomography scans were carried out, and patients were classified into various categories such as leak with/without septicemia and leak with or without extravasation of contrast. All the patients were managed differently based on the category they belonged to. Results: Over a period of 3 years, out of 1393 cases of gastric bypass, 11 patients (0.78%) were diagnosed with postoperative JJ AL within 6 weeks of the postoperative period. The earlier cases were extensively treated with diagnostic laparoscopy along with local lavage, insertion of a feeding jejunostomy tube, leakage site drainage, proximal drainage, and nasogastric decompression with or without intensive care, causing considerable hospital stay and increased morbidity. With experience, we realized that all patients with leaks do not require extensive management. We have eventually determined an algorithm to manage JJ ALs depending on clinical and radiological parameters. Conclusion: Our individualized and effective algorithm-based management protocol results in quicker recovery, optimizes the intervention, and minimizes hospital stay, morbidity, and mortality after postoperative JJ AL. It can potentially mitigate the cost burden in India while ensuring a better outcome. This retrospective pilot study can be a practical guideline for the optimal management of JJ ALs after gastric bypass.