Technical Factors Associated with Anastomotic Leak after Roux-en-Y Gastric Bypass
Identifieur interne : 000F88 ( Main/Exploration ); précédent : 000F87; suivant : 000F89Technical Factors Associated with Anastomotic Leak after Roux-en-Y Gastric Bypass
Auteurs : M. D. Smith [États-Unis] ; A. Adeniji [États-Unis] ; A. S. Wahed [États-Unis] ; E. Patterson [États-Unis] ; W. Chapman [États-Unis] ; A. P. Courcoulas [États-Unis] ; G. Dakin [États-Unis] ; D. Flum [États-Unis] ; C. Mccloskey [États-Unis] ; J. E. Mitchell [États-Unis] ; A. Pomp [États-Unis] ; M. Staten [États-Unis] ; B. Wolfe [États-Unis]Source :
- Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery [ 1550-7289 ] ; 2014.
Descripteurs français
- KwdFr :
- Adhésifs tissulaires (usage thérapeutique), Adulte, Adulte d'âge moyen, Dérivation gastrique (effets indésirables), Désunion anastomotique (), Désunion anastomotique (épidémiologie), Femelle, Humains, Incidence, Laparoscopie (), Mâle, Obésité morbide (), Réintervention, Sujet âgé, États-Unis d'Amérique (épidémiologie).
- MESH :
- effets indésirables : Dérivation gastrique.
- usage thérapeutique : Adhésifs tissulaires.
- épidémiologie : Désunion anastomotique, États-Unis d'Amérique.
- Adulte, Adulte d'âge moyen, Désunion anastomotique, Femelle, Humains, Incidence, Laparoscopie, Mâle, Obésité morbide, Réintervention, Sujet âgé.
- Wicri :
- geographic : États-Unis.
English descriptors
- KwdEn :
- MESH :
- chemical , therapeutic use : Tissue Adhesives.
- geographic , epidemiology : United States.
- adverse effects : Gastric Bypass.
- epidemiology : Anastomotic Leak.
- methods : Laparoscopy.
- surgery : Anastomotic Leak, Obesity, Morbid.
- Adult, Aged, Female, Humans, Incidence, Male, Middle Aged, Reoperation.
Abstract
Anastomotic leak is one of the most serious complications following Roux-en-Y gastric bypass (RYGB).
To examine the relationship between technical factors and incidence of clinically relevant anastomotic leak following RYGB in Longitudinal Assessment of Bariatric Surgery (LABS).
Eleven bariatric centers in the United States, University and Private Practice.
Patient characteristics, technical factors of surgery, and postoperative outcomes were assessed by trained researchers using standardized protocols. Correlation of surgical factors of patients undergoing RYGB (n=4444) with the incidence of post-operative anastomotic leak was assessed by univariate chi-squared analysis.
Forty-four participants (1.0%, 95%CI 0.7% to 1.3%) experienced a clinically relevant anastomotic leak. Of these, 39 (89%) underwent abdominal re-operation and 3 (7%) died. Technical factors associated with anastomotic leak were open surgery (p<0.0001), revision surgery (p<0.0001) and use of an abdominal drain (p=0.02). Provocative leak testing, method of gastrojejunostomy and use of fibrin sealant were not associated with anastomotic leak.
Anastomotic leak following RYGB was rare (1.0%). Most cases required reintervention, however, the majority (93%) recovered from this event. Open surgery, revision surgery and routine drain placement were associated with increased leak rate. Some of these findings may be due to differences in pre-operative patient risk.
Url:
DOI: 10.1016/j.soard.2014.05.036
PubMed: 25595919
PubMed Central: 4425611
Affiliations:
- États-Unis
- Caroline du Nord, Connecticut, Dakota du Nord, Maryland, Oregon, Pennsylvanie, Washington (État), État de New York
- Ithaca (New York), Pittsburgh, Seattle
- Université Cornell, Université de Pittsburgh, Université de Washington
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D." last="Smith">M. D. Smith</name><affiliation wicri:level="2"><nlm:aff id="A1">Legacy Good Samaritan Medical Center, Portland, OR, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Legacy Good Samaritan Medical Center, Portland, OR</wicri:regionArea><placeName><region type="state">Oregon</region></placeName></affiliation></author><author><name sortKey="Adeniji, A" sort="Adeniji, A" uniqKey="Adeniji A" first="A." last="Adeniji">A. Adeniji</name><affiliation wicri:level="2"><nlm:aff id="A2">Boehringer Ingelheim, Ridgefield, CT, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Boehringer Ingelheim, Ridgefield, CT</wicri:regionArea><placeName><region type="state">Connecticut</region></placeName></affiliation></author><author><name sortKey="Wahed, A S" sort="Wahed, A S" uniqKey="Wahed A" first="A. S." last="Wahed">A. S. Wahed</name><affiliation wicri:level="4"><nlm:aff id="A3">University of Pittsburgh, Pittsburgh, PA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>University of Pittsburgh, Pittsburgh, PA</wicri:regionArea><placeName><region type="state">Pennsylvanie</region><settlement type="city">Pittsburgh</settlement></placeName><orgName type="university">Université de Pittsburgh</orgName></affiliation></author><author><name sortKey="Patterson, E" sort="Patterson, E" uniqKey="Patterson E" first="E." last="Patterson">E. Patterson</name><affiliation wicri:level="2"><nlm:aff id="A1">Legacy Good Samaritan Medical Center, Portland, OR, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Legacy Good Samaritan Medical Center, Portland, OR</wicri:regionArea><placeName><region type="state">Oregon</region></placeName></affiliation></author><author><name sortKey="Chapman, W" sort="Chapman, W" uniqKey="Chapman W" first="W." last="Chapman">W. Chapman</name><affiliation wicri:level="2"><nlm:aff id="A4">Department of Surgery, East Carolina University School of Medicine, Greenville, NC, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Surgery, East Carolina University School of Medicine, Greenville, NC</wicri:regionArea><placeName><region type="state">Caroline du Nord</region></placeName></affiliation></author><author><name sortKey="Courcoulas, A P" sort="Courcoulas, A P" uniqKey="Courcoulas A" first="A. P." last="Courcoulas">A. P. Courcoulas</name><affiliation wicri:level="2"><nlm:aff id="A5">University of Pittsburgh Medical Center, Pittsburgh, PA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>University of Pittsburgh Medical Center, Pittsburgh, PA</wicri:regionArea><placeName><region type="state">Pennsylvanie</region></placeName></affiliation></author><author><name sortKey="Dakin, G" sort="Dakin, G" uniqKey="Dakin G" first="G." last="Dakin">G. Dakin</name><affiliation wicri:level="4"><nlm:aff id="A6">Cornell University, New York, NY, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Cornell University, New York, NY</wicri:regionArea><placeName><region type="state">État de New York</region><settlement type="city">Ithaca (New York)</settlement></placeName><orgName type="university">Université Cornell</orgName></affiliation></author><author><name sortKey="Flum, D" sort="Flum, D" uniqKey="Flum D" first="D." last="Flum">D. Flum</name><affiliation wicri:level="4"><nlm:aff id="A7">Department of Surgery, University of Washington, Seattle, WA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Surgery, University of Washington, Seattle, WA</wicri:regionArea><placeName><region type="state">Washington (État)</region><settlement type="city">Seattle</settlement></placeName><orgName type="university">Université de Washington</orgName></affiliation></author><author><name sortKey="Mccloskey, C" sort="Mccloskey, C" uniqKey="Mccloskey C" first="C." last="Mccloskey">C. Mccloskey</name><affiliation wicri:level="2"><nlm:aff id="A5">University of Pittsburgh Medical Center, Pittsburgh, PA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>University of Pittsburgh Medical Center, Pittsburgh, PA</wicri:regionArea><placeName><region type="state">Pennsylvanie</region></placeName></affiliation></author><author><name sortKey="Mitchell, J E" sort="Mitchell, J E" uniqKey="Mitchell J" first="J. E." last="Mitchell">J. E. Mitchell</name><affiliation wicri:level="2"><nlm:aff id="A8">Neuropsychiatric Research Institute, Fargo, ND, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Neuropsychiatric Research Institute, Fargo, ND</wicri:regionArea><placeName><region type="state">Dakota du Nord</region></placeName></affiliation></author><author><name sortKey="Pomp, A" sort="Pomp, A" uniqKey="Pomp A" first="A." last="Pomp">A. Pomp</name><affiliation wicri:level="4"><nlm:aff id="A6">Cornell University, New York, NY, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Cornell University, New York, NY</wicri:regionArea><placeName><region type="state">État de New York</region><settlement type="city">Ithaca (New York)</settlement></placeName><orgName type="university">Université Cornell</orgName></affiliation></author><author><name sortKey="Staten, M" sort="Staten, M" uniqKey="Staten M" first="M." last="Staten">M. Staten</name><affiliation wicri:level="2"><nlm:aff id="A9">National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD</wicri:regionArea><placeName><region type="state">Maryland</region></placeName></affiliation></author><author><name sortKey="Wolfe, B" sort="Wolfe, B" uniqKey="Wolfe B" first="B." last="Wolfe">B. Wolfe</name><affiliation wicri:level="2"><nlm:aff id="A10">Oregon Health and Science University, Portland, OR, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Oregon Health and Science University, Portland, OR</wicri:regionArea><placeName><region type="state">Oregon</region></placeName></affiliation></author></analytic><series><title level="j">Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery</title><idno type="ISSN">1550-7289</idno><idno type="eISSN">1878-7533</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Aged</term><term>Anastomotic Leak (epidemiology)</term><term>Anastomotic Leak (surgery)</term><term>Female</term><term>Gastric Bypass (adverse effects)</term><term>Humans</term><term>Incidence</term><term>Laparoscopy (methods)</term><term>Male</term><term>Middle Aged</term><term>Obesity, Morbid (surgery)</term><term>Reoperation</term><term>Tissue Adhesives (therapeutic use)</term><term>United States (epidemiology)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adhésifs tissulaires (usage thérapeutique)</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Dérivation gastrique (effets indésirables)</term><term>Désunion anastomotique ()</term><term>Désunion anastomotique (épidémiologie)</term><term>Femelle</term><term>Humains</term><term>Incidence</term><term>Laparoscopie ()</term><term>Mâle</term><term>Obésité morbide ()</term><term>Réintervention</term><term>Sujet âgé</term><term>États-Unis d'Amérique (épidémiologie)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Tissue Adhesives</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>United States</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Gastric Bypass</term></keywords><keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Dérivation gastrique</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Anastomotic Leak</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Laparoscopy</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Anastomotic Leak</term><term>Obesity, Morbid</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Adhésifs tissulaires</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Désunion anastomotique</term><term>États-Unis d'Amérique</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Female</term><term>Humans</term><term>Incidence</term><term>Male</term><term>Middle Aged</term><term>Reoperation</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Désunion anastomotique</term><term>Femelle</term><term>Humains</term><term>Incidence</term><term>Laparoscopie</term><term>Mâle</term><term>Obésité morbide</term><term>Réintervention</term><term>Sujet âgé</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>États-Unis</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title><p id="P2">Anastomotic leak is one of the most serious complications following Roux-en-Y gastric bypass (RYGB).</p></sec><sec id="S2"><title>Objective</title><p id="P3">To examine the relationship between technical factors and incidence of clinically relevant anastomotic leak following RYGB in Longitudinal Assessment of Bariatric Surgery (LABS).</p></sec><sec id="S3"><title>Setting</title><p id="P4">Eleven bariatric centers in the United States, University and Private Practice.</p></sec><sec id="S4"><title>Methods</title><p id="P5">Patient characteristics, technical factors of surgery, and postoperative outcomes were assessed by trained researchers using standardized protocols. Correlation of surgical factors of patients undergoing RYGB (n=4444) with the incidence of post-operative anastomotic leak was assessed by univariate chi-squared analysis.</p></sec><sec id="S5"><title>Results</title><p id="P6">Forty-four participants (1.0%, 95%CI 0.7% to 1.3%) experienced a clinically relevant anastomotic leak. Of these, 39 (89%) underwent abdominal re-operation and 3 (7%) died. Technical factors associated with anastomotic leak were open surgery (p<0.0001), revision surgery (p<0.0001) and use of an abdominal drain (p=0.02). Provocative leak testing, method of gastrojejunostomy and use of fibrin sealant were not associated with anastomotic leak.</p></sec><sec id="S6"><title>Conclusions</title><p id="P7">Anastomotic leak following RYGB was rare (1.0%). Most cases required reintervention, however, the majority (93%) recovered from this event. Open surgery, revision surgery and routine drain placement were associated with increased leak rate. Some of these findings may be due to differences in pre-operative patient risk.</p></sec></div></front></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>Caroline du Nord</li><li>Connecticut</li><li>Dakota du Nord</li><li>Maryland</li><li>Oregon</li><li>Pennsylvanie</li><li>Washington (État)</li><li>État de New York</li></region><settlement><li>Ithaca (New York)</li><li>Pittsburgh</li><li>Seattle</li></settlement><orgName><li>Université Cornell</li><li>Université de Pittsburgh</li><li>Université de Washington</li></orgName></list><tree><country name="États-Unis"><region name="Oregon"><name sortKey="Smith, M D" sort="Smith, M D" uniqKey="Smith M" first="M. D." last="Smith">M. D. Smith</name></region><name sortKey="Adeniji, A" sort="Adeniji, A" uniqKey="Adeniji A" first="A." last="Adeniji">A. Adeniji</name><name sortKey="Chapman, W" sort="Chapman, W" uniqKey="Chapman W" first="W." last="Chapman">W. Chapman</name><name sortKey="Courcoulas, A P" sort="Courcoulas, A P" uniqKey="Courcoulas A" first="A. P." last="Courcoulas">A. P. Courcoulas</name><name sortKey="Dakin, G" sort="Dakin, G" uniqKey="Dakin G" first="G." last="Dakin">G. Dakin</name><name sortKey="Flum, D" sort="Flum, D" uniqKey="Flum D" first="D." last="Flum">D. Flum</name><name sortKey="Mccloskey, C" sort="Mccloskey, C" uniqKey="Mccloskey C" first="C." last="Mccloskey">C. Mccloskey</name><name sortKey="Mitchell, J E" sort="Mitchell, J E" uniqKey="Mitchell J" first="J. E." last="Mitchell">J. E. Mitchell</name><name sortKey="Patterson, E" sort="Patterson, E" uniqKey="Patterson E" first="E." last="Patterson">E. Patterson</name><name sortKey="Pomp, A" sort="Pomp, A" uniqKey="Pomp A" first="A." last="Pomp">A. Pomp</name><name sortKey="Staten, M" sort="Staten, M" uniqKey="Staten M" first="M." last="Staten">M. Staten</name><name sortKey="Wahed, A S" sort="Wahed, A S" uniqKey="Wahed A" first="A. S." last="Wahed">A. S. Wahed</name><name sortKey="Wolfe, B" sort="Wolfe, B" uniqKey="Wolfe B" first="B." last="Wolfe">B. Wolfe</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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