Leaks After WLS: Causes, Symptoms & TreatmentsFebruary 18, 2016
If you are considering the possibility of gastric bypass or sleeve surgery, you may have a number of questions about the possible complications. Though these procedures come with certain risks such as nausea, vomiting, wound infection and dehydration; the less common risk of gastrointestinal (GI) leaks after WLS are perhaps the most feared – and misunderstood – of all.
GI leaks used to be a much more common complication of weight loss surgery, but time and experience have drastically reduced their occurrence. In fact, the American Society for Metabolic and Bariatric Procedures says that GI leaks are now only being reported in between 1% and 5% of open and laparoscopic gastric bypass surgeries.
Having a basic understanding about GI leaks will help you make an informed decision as you discuss them with your doctor. Perhaps the best way to understand a leak is to compare it with basic plumbing concepts. For example, when fitting two pipes together, you hope to prevent any leakage between them. Weight loss surgery works in a similar way to connect the stomach with the small bowel. The surgeon’s goal is to avoid any kind of leakage from the GI tract into the abdomen which can cause serious inflammation and irritation. Leak tests are performed as needed after every procedure, and they occasionally detect the presence of a small gap that is not healing and leading to leakage.
Leaks After WLS Can Be Serious
Leaks can be serious and even life-threatening if not treated right away. Symptoms can vary from case to case and may include subtle abdominal pain, increased vomiting, increased heart rate, confusion, and elevated white blood cell counts. Leaks can also be difficult to detect, especially when a patient is overweight, and many of these same symptoms can occur during normal recovery. Perhaps the most telling symptom is when a patient’s heart rate is elevated and their condition is not improving.
You should be closely monitored for a potential leak within the first few days after surgery, but a leak can happen up to four weeks after your procedure is done. Be aware of the potential warning signs after your surgery, and seek your doctor’s advice if you experience increased abdominal pain and heart rate, fever, or the inability to tolerate your prescribed diet. Each of these should prompt you to contact your doctor immediately or visit the emergency room. Simply ignoring them can lead to problems such as malnutrition and dehydration, infection, and blood clots of your leg or lung.
Testing and Confirming a Leak
It’s important for leaks to be diagnosed quickly. Thankfully, there are many ways doctors can test and confirm the presence of a leak. Testing may include either an exam of your upper GI tract, a CT scan, or both. The CT scan is typically the more accurate of the two tests but a leak can still happen even after receiving negative results from both. As a result, your surgeon may choose to do a surgical procedure to fully confirm the absence or presence of a leak.
If your doctor finds a leak it may be treated in a number of ways: If it is small and uninfected, your doctor may choose to administer IV antibiotics while closely monitoring your condition. If there’s an infection, a tube may be surgically inserted to drain it, or a stent may be inserted to cover the hole where the leak is occurring. Your doctor would also use a G-tube to make sure you are getting proper nutrition. In some cases, doctors use additional surgery to close and seal the leak in order for it to properly heal. Recovery can take as little as a week for small leaks or up to several months if surgery is needed.
Leakages are occurring much less frequently as doctors become better trained, and surgeries are performed laparoscopically. In addition, newer diagnostic tools have given us the ability to better detect the presence of leaks and treat them more aggressively before a patient’s condition worsens. In addition to a leak, other complications might occur such as a stricture or a bowel obstruction. As you become more educated, it allows you to effectively partner with your doctor and make the right choices to determine your best course of treatment.
ABOUT THE AUTHORMujeeb Siddiqui, DO, FACOS, approaches each patient with an empathetic, honest attitude, working to create individualized care plans that result in positive life changes. His patients also receive committed follow-up care. Dr. Siddiqui practices with Premier Metabolic and Bariatric Associates, part of Premier Health Specialists, one of the largest groups of specialty care practices in Southwest Ohio.
Photo credit: Amy Kellogg