Features of therapeutic tactics for the failure of gastrointestinal anastomosis in patients with morbid obesity after Roux-en-Y gastric bypass

Abstract

Background: Roux-en-Y gastric bypass is the main type of bariatric surgery. The most formidable and severe complication in morbid obesity patients after gastric bypass is gastrojejunostomy leak. Aim: to study the possibilities of improving treatment outcomes of obese patients during gastrojejunostomy leak after gastric bypass surgery using new minimally invasive methods. Methods: This retrospective cohort descriptive study included all patients with gastrojejunostomy leak after gastric bypass treated in the Department of Surgery of the Federal State Budgetary Institution Federal Scientific and Practical Center of the Federal Medical and Biological Agency of Russia in 20192022. In total, 445 gastric bypasses were performed during this period, and seven patients (1.6%) developed HEA failure in the postoperative period. Results: The results of treatment of gastroenteroanastomotic leaks during gastric bypass in patients with morbid obesity are presented. The early diagnosis of gastroenteroanastomosis failure in this category of patients was difficult. All doubts in the diagnosis of anastomotic failure should be completed by revision laparoscopy with intraoperative esophagogastroscopy. Minimally invasive techniques (surgical, endoscopic), drug therapy, and adequate nutritional support are crucial for managing patients with anastomotic leaks. Conclusion: The use of an endoscopic intraluminal vacuum aspiration system in the treatment of gastroenteroanastomotic insufficiency avoids the spread of inflammation in the abdominal cavity, accelerates the reparative process in the area of insufficiency, and, in most cases, avoids programmed sanitation, significantly improving the treatment results.

Keywords

• morbid obesity
• gastroenteroanastomosis failure
• gastric bypass surgery
• endoscopic intra-luminal vacuum aspiration system
• minimally invasive methods