Successful Endoscopic Management of Gastrojejunal Anastomotic Leak Following Open Roux-en-Y Gastric Bypass

Abstract

Gastrojejunal anastomotic leak following Roux-en-Y gastric bypass (RYGB) for morbid obesity can lead to devastating and life-threatening intraabdominal sepsis. Typical management includes external drainage of the intraperitoneal collection with a risk of long lasting and difficult to manage gastrocutaneous fistula. The situation is additionally aggravated by the nature of a severely obese patient with multiple comorbidities and a modified gastrointestinal anatomy. In the reported case, the gastrojejunal leak after an open RYGB was successfully managed by a combined laparoscopic and gastroscopic intervention with a nasogastric drainage of intraabdominal collection. The quick recovery of the patient was based on the minimally invasive nature of the procedure and early aggressive enteral feeding via gastric remnant. Intraoperative gastroscopy allowed confirmation of the absence of free intraperitonel leakage and guided nasogastric drainage of the abscess. This report confirms the feasibility of a laparoscopic revision after open RYGB for a contained gastrojejunal insufficiency when it is combined with on-table gastroscopy. doi:10.4021/jmc252w