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

Author:

Patolia Sanjay1,Patolia Hetal23,Bhalodia Dhara4,Patel Himmat5,Kapadia Mandeep6

Affiliation:

1. Department of Bariatric and Metabolic Surgery, Khyati Multispeciality Hospital, Ahmedabad, India

2. Department of Bariatric and Metabolic Surgery, Khyati Multispeciality Hospital and SGVP Hospital, Ahmedabad, India

3. Department of Bariatric and Diet, New Life Obesity Care Pvt. Ltd., Rajkot, Gujarat, India

4. Department of Bariatric Diet, Khyati Multispeciality Hospital, Ahmedabad, India

5. Department of Bariatric, Khyati Multispeciality Hospital, Ahmedabad, India

6. Department of Bariatric and Metabolic Surgery, New Life Hospital, Rajkot, Gujarat, India

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.

Publisher

Medknow

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3