Management of Leaks Following Gastric Bypass

The Roux-en-Y Gastric Bypass is one of the most commonly performed bariatric procedures in the world. Despite its effectiveness and safety, complications may arise. Leaks are one of the most worrisome outcomes and carry high morbidity and mortality levels. Treatment of leaks following Roux-en-Y Gastric Bypass is demanding and requires a multidisciplinary approach. Acute leaks within the three first postoperative days might reflect a technical error, and a surgical approach should be considered. Also, if the patient presents with any sign of clinical instability, urgent surgery is considered the standard of care for most situations. This approach encompasses thorough peritoneal cleansing, adequate drainage, and possibly repair of the defect. Meanwhile, non-acute leaks in clinically stable patients should be managed non-operatively. Four pivotal principles compose the adequate conservative treatment: adequate drainage; systemic clinical treatment; diagnosis and repair of factors that may impair healing; endoscopic approach focused on closing the defect or providing internal drainage and healing by secondary intention. Over the last several years, new technology has been developed that has contributed to a less invasive and more effective clinical outcome for these patients. In this chapter, we detail the four pivotal principles and summarize the recently developed methods and technologies.