Reoperation for Repair of Anastomotic Leaks and Staple Line Disruptions

Although uncommon, postoperative anastomotic leaks (AL) and staple line disruptions (SLD) after bariatric surgery are a matter of critical importance. Proper and timely intervention will minimize the morbidity and mortality associated with the rapid progression from systemic inflammatory response to sepsis and shock. The causes for AL and SLD depend on patient and technical factors. Given its ambiguous clinical presentation, from asymptomatic to sepsis and death, a high index of suspicion is imperative to expedite recognition and early initiation of management. For hemodynamically stable patients, the surgeon’s clinical suspicion can be confirmed with the assistance of laboratory studies, upper gastrointestinal (UGI) contrast studies, and computed tomography (CT) scan. Non-operative management includes control of local and systemic sepsis, control of gastrointestinal secretions, and early nutritional support. Successful management has also been reported using minimally invasive endoscopic techniques. In the face of clinical deterioration or unsuccessful non-operative management, operative intervention involves re-exploration with extensive irrigation and drainage, with or without repair of the leak. Endoscopic stenting and revisional surgery are discussed in Chaps. 26 and 28, respectively.