Abstracts
2000 Digestive Disease Week

# 2337 Gastrointestinal Leaks Following Laparoscopic Gastric Bypass (LGBP).
Philip R. Schauer, Sayeed Ikramuddin, Higa, Pittsburgh, PA

LGBP is a new procedure requiring highly advanced laparoscopic skills. The incidence and mechanisms of postoperative leaks is unknown. Methods: Surgeons with advanced laparoscopic experience, and 25 LRGBP s were selected to join a multicenter study group that evaluated leaks related to LGBP. Results: Fourteen surgeons) with an experience of 25-420 cases (mean 126) from 8 centers completed 1264 LGBP cases (from 1992-1999) resulting in 23 postoperative leaks (1.8%). Location of the leaks included the gastrojejunal anastomosis (12), gastric pouch staple line (7), gastric remnant staple line (2), entero-enterostomy (1), and the esophagus (1). Thirteen patients presented with obvious sepsis while 10 were subclinical. The diagnosis was made by UGI (11), unusual drain output (7), CT scan (3), or surgery (2) on postoperative day 1-14 (mean 5). Fourteen of the leaks were life threatening causing peritonitis. Management included operative repair and/or drainage in 16 (6 laparoscopic), percutaneous drainage (3), or no drainage with TPN/enteral feeding (4). Fourteen patients (61%) required ICU care (mean 6.6 days) and the hospital stay ranged from 3-90 days (mean 16). The mortality in patients with a leak was 4.3% (1/23). For the surgeons with > 130 cases (mean 218), 50% of the leaks occurred in the first 50 cases. Cause of leaks was thought to be staple line failure (8), excess tension/ischemia (7), distal obstruction (4), gastric distention (2), or NG tub perforation (2). Conclusion: Leaks resulting from LGBP appear to have a similar incidence compared to open gastric bypass, are associated with high morbidity, and may be related to a learning curve. Adequate training for this highly advanced procedure is recommended to avoid potentially lethal gastrointestinal leaks.