When a weight loss surgery leak happens, particularly from the stomach, the acid from the stomach and some of the digestive enzymes get out and cause an intense burn inside. This makes patients very sick, although sometimes obese patients don’t show symptoms as well as non-obese patients. Early leaks are very difficult to detect.
If you have a Gastric Bypass surgery leak
The chemicals (acid and enzymes) from the stomach cause an intense reaction in the tissues. The tissues become swollen, and they don’t hold stitches well. If you try to sew them, it is like sewing wet tissue paper together. Often times they cannot hold a stitch and the only thing you can do is place a drain in the area and hope that the drain will carry away the noxious fluids, allowing the body to heal itself. Sometimes the surgeon has to cut out the inflamed tissues to find good tissue to sew, but often this isn’t the time or place to do it. The drain will provide a place for the material to leave the stomach, and the body will wall those materials off, protecting the rest of the inside of the body. If the body is unable to close off the hole, sometimes months later a surgeon can go in and repair it—when all of the inflammation, swelling, and scar tissue has calmed down. Some leaks, however, when caught early, are simply sewn back together, and it is just means a few extra days in the hospital. These patients are very lucky.
During this time, you need to good nutrition, yet don’t need anything that might aggravate the leak. Your surgeon might insert a special feeding tube in your bowel, or put you on intravenous nutrition (called Total Parentral Nutrition, TPN). You may need to be on this for months. Sometimes the insides become so inflamed and scarred that the surgery has to be revised. You might be able to have another bariatric surgery another time, maybe not.
Sometimes the insides become so inflamed and scarred that the surgery has to be revised.Can someone die from a leak? Oh yes. A leak is similar to a perforated ulcer. Once a patient develops a leak he or she become very sick and may require days or weeks on a machine to help them breathe. So, when the surgeon says you can go back to work in three weeks, remember—he means if everything goes well. In the best of surgical hands 1.5 percent of patients will develop a leak. Some of those patients will die, some of those patients will spend months in the hospital and recovering in rehabilitation, and a few lucky ones will just require another surgery.
What is a weight loss surgery leak test?
Surgeons always worry about leaks. We watch patients carefully for any sign that one might be developing so that we can treat the leak as soon as possible and prevent as much damage as possible.
Some surgeons, as a matter of routine, on a certain post op day, have patients swallow a liquid which tastes pretty bad. They then order a series of x-rays that are designed to show if there is a leak. Some do this on the second to fifth day, but these tests are not always as sensitive as they might seem. Some surgeons check for leaks during the time of the surgery, and some surgeons do not. There is no right or wrong way to do this, nor does checking for a leak on the second post operative day mean that you won’t develop a leak on the fifth post operative day. If a surgeon suspects a leak, then checking x-rays is an important tool. Some radiology equipment can not handle patients who weigh over 500 lbs. If you are over 500 lbs and your doctor suspects you have a leak, then this is one test that your hospital may not be able to provide. We could just pump you full of air, submerge you in a bathtub and see if bubbles come out—like a bicycle inner tube. Just don’t drink carbonated beverages before the test.
Leaks between the two pouches in Roux en Y gastric bypass surgery
In the Roux en Y Gastric Bypass, some surgeons completely separate the upper pouch from the stomach. Other surgeons simply staple the stomach into two parts. If they are stapled off, a leak might develop from the upper pouch to the lower pouch. This leak does not cause severe illness. Instead, it allows the lower pouch to fill with food, so patients can eventually eat more and more and lose the effect of surgery. Some of these types of leaks seal, and some do not. Some patients do fine with this, and others require surgical revision.
Removing the spleen if it becomes injured during bariatric surgery
The spleen, a very vascular organ, sits next to the stomach. If the spleen is injured during surgery, sometimes it needs to be removed. Some quote splenic injury rate at two percent, although a study that looked at this carefully found upper abdominal surgery involving the junction of the stomach and esophagus (which is where we are) can have an injury rate of 11%.
The function of the spleen is debated, so many surgeons try to save the spleen. However, sometimes it cannot be done with safety. The spleen is responsible for removing some items from the blood—especially certain forms of bacteria like the one that causes pneumonia. You can live very well without your spleen, but if your spleen is removed during surgery we recommend you have a vaccine for Pneumococcus and also for meningitis, if one is offered at your hospital. Typically, the vaccination should be at least six weeks after the spleen is removed.
Roux en Y gastric bypass lower pouch distention
After RNY gastric bypass, sometimes the lower pouch becomes filled with gas. If this happens it can require surgery, but sometimes a radiologist can put a tube in the lower stomach to keep it decompressed for a while. This can happen at any time to anyone who has had a Roux en Y gastric bypass, but typically it occurs in the first few weeks. Some surgeons place a feeding tube in the lower pouch, which can also serve as a valve to relieve the gas.