Gastric bypass weight loss surgery leaks - RNY, Duodenal Switch, etc...

When a surgeon puts together bowel that has been drawn asunder, potential for a leak exists. An “anastomosis” is the term we use for when we put two pieces of bowel together.

Just like when you repair a garden hose, if the two ends don’t heal well together they can spring a leak. This often requires the surgeon to take the patient back to the operating room to fix the leak, or at least to drain the area. Sometimes patients spend weeks in intensive care, go to rehabilitation units, and have a prolonged course of treatment. Sometimes patients have drains in them for months before the leaks slowly close up. If you go back to the operating room you can count on, at the least, spending an extra few days in the hospital.

Anastomosis of any bowel can leak, they can leak for a variety of reasons, and repairing them it doesn’t mean that they will stay together. That is the frustrating part of surgery. No matter who does the surgery, how the surgery is done, or what sutures or staples are used, the connection between them is subject to variables which are beyond the surgeon’s control. You might think that a surgeon can just open a patient up, put in a few sutures to sew up the leak, and everything will be fine—but it doesn’t work that way.

Bowel is a living thing, and when you sew two pieces of bowel together a certain environment has to exist for the bowel to graft onto the other bowel and form a unit. Putting bowel together, or making an anastomosis, is a lot like grafting branches on a tree—the environment has to be correct for it to work. When a patient has one leak, they are more likely to have another leak. So, even if the surgeon takes the patient back to the operating room and fixes them, the patient can leak again.

Well meaning family members think this must be the surgeon’s fault, but often it has nothing to do with the skill of that surgeon. The factors that caused the leak the first time may still be present to cause a leak again. Many things can cause leaks and inhibit healing. For example, certain chemotherapy drugs, steroids, radiation, cigarettes, infection, some inflammatory diseases can inhibit healing. There are three main causes of a leak: the blood supply to the bowel can be a bit compromised and it doesn’t heal together that well, there can be some tension on the anastomosis that tends to pull it apart, or there is some mechanical reason for it not healing well. During You can develop a leak days after the surgery even though the surgeon took all precautions. surgery, many of us check the bowel for leaks, and while that eliminates one source of concern, we have little means of knowing how well the two ends will heal. Sometimes there are small leaks that seal by themselves.

Bowel is put back together in two ways: some surgeons use mechanical staples, and some hand sew each anastomosis. Mechanical staples are engineered to a precision better than any human can do by hand, they are uniform and somewhat fool proof. The argument for hand sewing two ends of bowel together is that you can tailor it to the circumstances. It really boils down to preference. Again, your surgeon has a certain way he does things, so don’t try to change how he operates because you like one way better than another.

Surgeons keep statistics on how many patients leak. Overall, if your surgery is done through the laparoscope, you have about a three percent chance of having a leak from the anastomosis. If your surgery is “open,” then the leak rate is 1.5 percent. Again, each surgeon has his or her own statistics. Some surgeons have done thousands of surgeries with few leaks, so ask your surgeon about his statistics. This is one question your surgeon should be able to answer

What you can do to prevent weight loss surgery leaks

Suffice it to say, we are all very happy when patients heal well. There are a few things you can do to help yourself heal faster.

STOP SMOKING. Oh, did I make that clear? If you smoke, you decrease the chance of bowel healing together. People who smoke have tissues that heal poorly, as the nicotine inhibits the new blood vessel growth in the anastomosis. Smokers not only have a higher incidence of leaks, but also of hernias. So, if you smoke, stop. Some bariatric surgeons refuse to operate on patients who smoke.

DO NOT OVER EAT. There is certain strength to bowel and stomach—we call it bursting strength, which is measured by how much pressure it takes to burst the bowel. When you cut bowel and you sew something new onto it, or you just divide them, the bowel is weakened. Over time the bowel regains a lot of its strength, but not right away. So, if you have a one-ounce pouch and decide you want to have an 8-ounce steak you might find yourself with a ruptured pouch and in a mess of trouble. Many surgeons won’t let their patients have carbonated beverages after this surgery, fearing that the rapid expansion of the carbonation coming out of the liquid will cause a rupture or stretch the stomach or pouch. Drinking and eating at the same time is also hard on the stomach. Your stomach does not care if the volume it sees is from liquids or solids, and volume is volume. So for some weeks after surgery we don’t recommend washing your food down with liquids.

WALK. The more you walk and get your body moving, the more air and nutrients move around, the better you will feel, and the faster you will heal—not only the anastomosis but your whole body.

GET OFF THE NARCOTICS. We want patients to be comfortable, and we want them to be comfortable enough to walk, but we cannot take all the pain away. Narcotics slow the gut down. Patients feel bloated, uncomfortable, and constipated. The sooner you can get off the narcotics and get off the couch the faster you will heal. Plus, if your gut gets backed up you won’t be able to eat well, and your stomach stays filled, and if you eat anyway, you can over fill it.

EAT PROPERLY. This seems obvious. But as your body heals it needs proper nutrients. You will not be able to eat much, and so some people eat what goes down well. What goes down well isn’t necessarily good for you or your stomach. Mashed potatoes go down well but their nutrient value isn’t as good as many other foods. We often have patients supplement their food with a daily vitamin. Bariatric patients need vitamin supplements more than anyone else.

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