Background

With the increasing number of revisional Roux-en-Y gastric bypass (RYGB) procedures performed, there is a need to better understand its postoperative complication profile, especially anastomotic leaks. The aim of this study is to evaluate the risk factors associated with leaks after revisional RYGB using the MBSAQIP database.

Methods

The 2020-2021 MBSAQIP database was queried for all revisional RYGB cases. Two cohorts were identified based on the occurrence of a leak. Univariate and multivariate stepwise logistic regression were used to identify demographic variables, co-morbidities, and operative factors associated with the occurrence of a postoperative leak.

Results

A total of 21,352 revisional RYGB were identified with 122 cases (0.6%) developed a leak. Patients in the leak group were of comparable age, race, sex, and body mass index. Most conversions were from a sleeve gastrectomy (71.7%) or an adjustable gastric band (22.1%). On univariate analysis, history of venous thromboembolic events (VTEs), hyperlipidemia, sleep apnea, intraoperative drain placement, and conversion to open were higher in the leak group. After adjustment for significant covariates, preoperative history of VTEs (10.7% vs 3.4%; p<0.01; AOR 3.43), chronic obstructive pulmonary disease (3.3% vs 1.1%; p=0.05; AOR 3.03), hyperlipidemia (28.7% vs 19.6%; p=0.01; AOR 1.69), and obstructive sleep apnea (34.4% vs 26.3%; p=0.05; AOR 1.51) were associated with the occurrence of a leak.

Conclusions

Despite its relatively low rate, leaks after revisional RYGB are associated with several preoperative comorbidities. Further prospective studies are required to validate these findings.