Surgical Treatment of Chronic Gastrointestinal Leaks after Bariatric Surgery

Abstract Background: Patients with chronic gastro-jejunal leaks following bariatric surgery often require resection of the gastric pouch or the stomach, contingent upon the initial procedure. In some cases, conversion to a Roux-en-Y Gastric Bypass (RYGB) is required, particularly in patients who underwent sleeve gastrectomy (SG). Materials and Methods: This study is a retrospective longitudinal analysis based on a prospectively maintained database of patients with a history of bariatric surgery and chronic, refractory gastric leaks who underwent definitive surgical treatment between 2008 and 2023. The initial operation and the previous attempts for closure were performed elsewhere in all patients, and they were referred for definitive surgical intervention to our center. Results: A total of 10 patients were included from the study. The initial surgical procedure was SG in eight patients and RYGB in two patients. Surgical procedures had been performed by either general or bariatric surgeons who did not mention any intraoperative complication. The interval between the onset of the leak and definitive treatment was 13 ± 9 months (range 0.6–26 months). Total gastrectomy with esophagojejunostomy was performed in nine patients, whereas one patient underwent conversion from SG to RYGB with resection of the gastric remnant. The average hospital stay was 9 ± 6 days (range 3–26 days). Postoperative complications were four wound infections, two leaks that resolved with conservative management, and one case of deep venous thrombosis. Late complications included abdominal hernia, small bowel obstruction, and migration of the esophagojejunostomy into the chest with partial obstruction. Conclusions: Resection-based treatment of chronic, refractory gastric leaks is an effective therapeutic strategy. However, the surgical approach is technically demanding, with a prolonged recovery period and a high complication rate.