Leaks & Stomach Perforation After WLS: Signs, Causes & Prevention
April 15, 2016Weight loss procedures help patients get a significant amount of weight off. Patients have improvements in mobility and co-morbid conditions such as sleep apnea, diabetes, high blood pressure, cholesterol and joint pain. All the benefits of weight loss are clearly evident to everyone.
How do we wrap our head around the risks vs. the benefits? Every time a surgeon evaluates someone for treatment, that’s what we do.
We look at all of the health conditions, consider what we are able to do and assess the individual risk for the patient based on the procedure we are planning. The risks of stomach perforation after weight loss surgery can include many things including a leak, bleeding or infection.
Signs of a Leak/Stomach Perforation
Leaks are the most complicated or time-consuming to treat. A leak means that one of the staple lines or anastomoses (new connections) is not watertight. The patient may feel pain in the upper abdomen or fever (>101.5 F) or a low-grade temperature. The surgeon or staff will order blood work and possibly an x-ray or CT scan.
Many times, patients have to go back to the operating room or undergo other procedures to help the leak (or perforated) area heal. The body can heal a leak but not without antibiotics. Also in order to heal, we have to drain the site of any fluid that leaks out of the stomach or intestines. Other procedures include re-operating thru the prior surgery sites or endoscopic (down the throat) methods with clips, stents or suturing.
Sometimes with a leak, patients will need a feeding tube in the stomach or in the first part of the intestine (jejunum). Other times, intravenous nutrition is necessary through a specially placed iv (PICC line because patients need nutrition to heal).
For any questions or concerns, make sure to contact your bariatric surgeon!
Cause of a Leak/Perforation
The cause of a leak or perforation is probably the hardest thing to determine. Everyone loves to know a cause and effect, yet every experienced surgeon in the world has had a leak. Leaks are a combination of tension in the tissues, blood supply and the pressure inside the stomach or intestine. Leaks are a known complication of all bariatric surgeries. What is most important is that the surgeon and staff are able to help treat your symptoms.
When a leak occurs, your surgeon will employ some of the different means I mentioned to control the leak and any infection that is present. The average time to heal a leak in a sleeve is about two months. Depending on the nature of the leak, it can be shorter or longer. Many of us have seen leaks that take longer to heal and leaks that connect to other organs. Despite the best available treatments, leaks can be hard to treat and frequently multiple modalities are necessary.
Prevent Risks of a Leak/Perforation
In the first few weeks after surgery, don’t gulp, don’t overeat, and follow the rules your surgical team has set out for you. Prevention of a leak may, at best, be minimizing risky or unpredictable behaviors. I like to have patients sip out of little medicine cups to help train for small sips. Every surgeon has a specific postoperative dietary plan that works best for the surgery they do, so be sure to follow it!
 | ABOUT THE AUTHOR Marina Kurian, MD has dedicated a significant part of her professional life to the treatment of obesity and making surgery less painful with minimally invasive techniques. Currently the Medical Director of the NYU Weight Management Program, Dr. Kurian is a New York City native and graduated from prestigious Stuyvesant High School. She was accepted into a combined six year college/medical school program and graduated at Albany Medical College. |
