Hi everyone - I apologize if this is in the wrong forum. I am looking for some advice on what to do after a second gastric leak.

My husband had a gastric sleeve done in late June 2014, and immediately had complications. He had a leak which caused an abdominal abscess and pleural effusion. He was on IV nutrition and took nothing by mouth for about 7 weeks before the leak healed. Once that healed, he was doing great. And then last month he started having shoulder pain and shortness of breath. The abdominal abscess was back along with another pleural effusion. At first the doctors thought it was a leftover pocket of infection. We've been in and out of the hospital, and on our third stay in a month they finally found a leak in the same location as his first leak last year. So back on TPN and we're hoping to be discharged today.

His surgery was done out of town (due to insurance) so we haven't seen his original surgeon yet, who will be taking over his care from this point forward. What are our options? Last time the surgeon wanted to let the leak heal on its own, but I'm concerned that we did that last time, and now a year later it's come back open.

It sounds complicated. Maybe get a 2nd opinion from another bariatric surgeon.

@liirogue Can you please tell me where he had the surgery done?

Surgery was done in Tulsa, OK

Oh okay. Was wondering if he went to Mexico or something. I had complications after surgery which required another emergency surgery but it wasn't a leak. That's scarey to have a leak after one year. I agree with OutsideMatchInside, go to a different doctor for a 2nd opinion.

You can still develop a leak a year out? I had know idea. I was under the impression that after that long you couldn't get a leak.

I know that for leaks, one true solution is to convert to a gastric bypass. For my surgeon, he tries several options first and if they are not successful, he concerts to a bypass which solves the problem. My surgeon also said late leaks (over one month post op) are harder to heal than one only a few days out from surgery.

Personally, it sounds like your husband has been through a lot and if this is the second leak in the same spot, I would not want to put him through more treatments/hospital stays again (that could end up not working anyway) and ask for a bypass. I am not a surgeon, just how I feel knowing what the options are. I would definitely consult with a Dr to see what the best plan of action is!

I know that for leaks, one true solution is to convert to a gastric bypass. For my surgeon, he tries several options first and if they are not successful, he concerts to a bypass which solves the problem. My surgeon also said late leaks (over one month post op) are harder to heal than one only a few days out from surgery.

I didn't know that a conversion to a bypass would be considered a solution. Do you know why or could you explain a little more please? Thanks!!

Edited September 19, 201510 yr by liirogue

You can still develop a leak a year out? I had know idea. I was under the impression that after that long you couldn't get a leak.

Yes we also thought he was out of the woods. Now we are worried that even if this leak heals, it could pop open again at any time...

A leak a year out?? So sorry to hear. A second and third opinion sound fitting. Will be praying for his fast and permanent recovery.

U can't get a bypass... The only option at this point would be duodenal switch but.. Don't think that's the answer... Sorry to hear of ur husbands misfortune

U can't get a bypass... The only option at this point would be duodenal switch but.. Don't think that's the answer... Sorry to hear of ur husbands misfortune

You can have bypass after a sleeve. In fact, sleeves were originally designed as a first step before bypass for extremely high BMIs.????

Actually, you can revise a sleeve to bypass. They take the remaining portion of stomach and treat it as if there was no sleeve, and turn that into a pouch, and create an anastomosis to the intestine. I would imagine this might work if the leak is in the portion of stomach this sewn up and bypassed, but the surgeon can answer that question.

The sleeve was originially intended to be the first surgery before a duodenal switch, not the first step of gastric bypass. They are two different procedures.

To the OP, so sorry to hear this! I have heard one other person on the boards report a leak a year out, so I know it can happen. Wishing your husband a speedy recovery.

Actually, you can revise a sleeve to bypass. They take the remaining portion of stomach and treat it as if there was no sleeve, and turn that into a pouch, and create an anastomosis to the intestine. I would imagine this might work if the leak is in the portion of stomach this sewn up and bypassed, but the surgeon can answer that question.

The sleeve was originially intended to be the first surgery before a duodenal switch, not the first step of gastric bypass. They are two different procedures.

To the OP, so sorry to hear this! I have heard one other person on the boards report a leak a year out, so I know it can happen. Wishing your husband a speedy recovery.

I'm aware of the difference. I'm a surgical nurse. ????thanks

I have a sleeve and I am being converted to bypass. So it can be done. Also, in a lot if literature they do say the sleeve was done as a first step to RNY. It is used to get weight down because it is a less invasive procedure for those with very high BMIs. I think people get caught up on the whole DS thing because everyone thinks the sleeve and DS just automatically go together. I wish you the best and hope they find a resolution fast for him!

Actually, you can revise a sleeve to bypass. They take the remaining portion of stomach and treat it as if there was no sleeve, and turn that into a pouch, and create an anastomosis to the intestine. I would imagine this might work if the leak is in the portion of stomach this sewn up and bypassed, but the surgeon can answer that question.

The sleeve was originially intended to be the first surgery before a duodenal switch, not the first step of gastric bypass. They are two different procedures.

To the OP, so sorry to hear this! I have heard one other person on the boards report a leak a year out, so I know it can happen. Wishing your husband a speedy recovery.

I'm aware of the difference. I'm a surgical nurse. thanks

I have a sleeve and I am being converted to bypass. So it can be done. Also, in a lot if literature they do say the sleeve was done as a first step to RNY. It is used to get weight down because it is a less invasive procedure for those with very high BMIs. I think people get caught up on the whole DS thing because everyone thinks the sleeve and DS just automatically go together. I wish you the best and hope they find a resolution fast for him!

http://bariatrictimes.com/the-history-of-sleeve-gastrectomy/

http://www.sages.org/wiki/laparoscopic-sleeve-gastrectomy/

https://asmbs.org/resources/story-of-obesity-surgery