WHAT IS LEAK?
The leak is a situation caused by nonhealing in stomach or bowel tissue. As a result, the contents of the stomach or intestine flow into the abdominal cavity and cause an inflammatory reaction there. This problem is a problem that can be seen after all gastrointestinal system surgeries. The reason for the leakage after bariatric surgery is either the increase in the internal pressure of the stomach or the staple line disruption due to the deterioration of tissue healing. Stomach internal pressure may increase due to the patient's intake of more fluid than he can drink at one time, consuming solid foods or drinking fizzy drinks. The reasons for the deterioration in wound healing may be due to the patient's general health or surgical reasons. Having clinical conditions such as diabetes mellitus, respiratory failure, heart failure, vitamin and mineral deficiencies, connective tissue diseases, or smoking may cause wound healing by disrupting wound healing. Failure of the surgeon to take care of the tissues during the surgery, to disturb the blood supply of the tissue or to sew it more or less frequently than necessary may be the cause of leakage. If there is a leak, saliva and stomach secretions and orally taken foods pass into the abdominal cavity. And it causes abscesses in the abdominal cavity. Therefore, symptoms such as stomachache, fever, nausea, vomiting, weakness, and loss of appetite appear in patients with leakage. Of course, all stomachaches, nausea and vomiting following surgery are not related to leakage. These symptoms are not unique symptoms of peritoneal inflammation, but also common symptoms of many diseases such as inflammation of the intestine, urinary tract and urinary tract, kidney stones, inflammatory conditions in the lower lung regions, or infarctions involving the lower face of the heart. When encountering such complaints, the most important thing is whether the severity of these symptoms is too much to force the patient to go to the doctor office.
If a patient with a history of bariatric surgery has the aforementioned symptoms and signs of abdominal inflammation were detected during the examination, the imaging procedure to be used to confirm the leak is computed tomography. Before the CT scan, the patient is given a water-soluble contrast agent and a tomography is taken. The diagnosis is confirmed if this contrast agent leaks out of the gastrointestinal tract in the presence of leakage. In such a case, the first thing to be done should be ensured that the patient's oral feeding is stopped and fed through the vein. Thus, excess liquid and food waste are prevented from escaping into the abdominal cavity in the first place. In order to reduce the acid secretion in the stomach and try to reduce the amount of acid escaping into the abdomen, drugs that prevent the release of stomach acid like pantoprazole should be given. In order to suppress the inflammatory reaction in peritoneum, antibiotics are given through the vein. If the abscess pouch seen in the tomography is large enough to be drained by placing a catheter from the outside, a catheter that is placed in the abscess cavity accompanied by ultrasound or tomography will discharge it. If less than 14 days have passed since the patient's surgery after the abscess drainage, the healing in the staple line is expected to strengthen sufficiently. In this process, if the amount of daily discharge coming from the catheter decreases gradually, it can be continued that almost a quarter of the cases are closed only by drainage. If there is no tendency to close spontaneously, endoscopic examination is performed in patients who have completed the 14th day and the leak location and size is determined. Coated stents, clip applications or internal drainages can be performed with the endoscope to cover the leak line so that the patient can be fed orally. If the leak is not closed with these methods, a second surgical intervention may be required, which is a very low possibility. In experienced centers, the rate of leakage is less than 1%; the rate of secondary surgery due to leakage is below one thousandth.
The risk of leakage is a situation that decreases day by day as the patient continues to improve on the stomach's staple line. Today, most of the leaks are of the type we call acute leak and it happens within the first 3 days. However, the latest leak reported in the literature is at the 18th month. However, this is a speculative diagnosis. Because we have no knowledge of endoscopical findings of the patient one week ago. In other words, this patient had an ulcer in the stapling line and it is not known whether it was pierced. The 18th month is a period where wound healing almost ends. No tissue cut and sewn will gain 100% of its former strength. 80% at the end of the first month, 92% at the 6th month and 98% at the 12th month. The 80% force reached in the first month is a very good healing rate. In order to safely complete the period of leakage, the patient should not drink fast liquid, increase the internal pressure of the stomach, do not consume carbonated drinks, and take solid food until the first month.