IBC Oxford University Poster Abstract 7 - Leakage after sleeve gastrectomy and gastric bypass. Roux-en-Y feeding jejunostomy. Management and treatment methods. Clinical case presentation

Abstract Background Leakage after Laparoscopic Sleeve Gastrectomy (LSG) and One Anastomosis Gastric Bypass (OAGB) is very rare, though it is too dangerous in bariatric surgery and one of the most serious complications associated with high morbidity rates and prolonged hospital stay, therefore, optimal treatment methods are very important. Basically, bariatric operations have been performed since 2009 in Georgia. Since then, up today have been made approximately 8263 operations, among them Sleeve Gastrectomy (LSG)-7550-91%, Mini-Gastric Bypass (OAGB)-653-8%, SADI-S-15-0.181%, Roux-en-Y-48 -0.58%. There were 37 cases of leakage, among them 5 patients died, that is 0.06% from the whole number of operations, bleeding-54, two died, that is 0.024%, stenosis-23 cases, none of them died, only 6 cases of thromboembolism, three of them died, that is 0.036%. Here we report the results of our experience about the treatment methods of leak among those patients, who need a long-term nutritional support and as well about the technical details. Methods We analysed three difficult cases of leak in our practice for the last year. One of them was operated by us, who was performed the LSG, then the leak was diagnosed after three days of the surgery. There were two cases in other hospitals, one of them was abroad. One was performed LSG, where the leak developed after the operation in a very short time, but unfortunately it was diagnosed four weeks later. The second patient was performed OAGB, and the leak was diagnosed after two weeks of the surgery by us in our hospital and in this case, it developed on the second day as well after the operation. In the first case the leak proved out on the staple line near the pylorus, the defect was sewed and fully closed for several days, and the patient left the hospital without any complication. In the other two cases were performed the abscess drainage (AD), stent placement and laparoscopic Roux-en-Y feeding jejunostomy (LRYFJ) for the prevention of the nutritional deficiency. Results As we mentioned, in our practice there were three cases of the leak after the bariatric operations, among them there were two female and one-male, the middle age was from 23 to 65 years, two of them underwent LRYFJ, because they needed a long-term nutritional support, because of prolonged leak. One of them, who was operated by us at first, stitching of the defect was done, the rest of them were referred to our hospital from another institution. The time between the first operation and the LRYFJ +Stenting procedures was about 15–30 days. One of them was finished by laparotomy and two-laparoscopically, the mean operative time was approximately 120 minutes, the enteral feeding began on the second day and the mean duration of the jejunal feeding was about 119 days. Conclusion According to our experience in bariatric surgery after leaking it is vital to make a proper and well-timed diagnosis, on which the length of the treatment, outcomes and staying in hospital depends. In such complicated cases the optimal.