Anastomosis is used when a hollow organ such as intestine needs to be severed and reconnected to allow fluids to flow through it, most commonly because part of the organ needs to be removed.An anastomotic leak is a breakdown along an anastomosis which causes fluid to leak.Leaks can occur for number of reasons and it is not always the mistake on the part of the surgeon.other reasons could be poor wound healing and unexpected stress and pressure on the anastomosed area.Patients who undergo bariatric surgery usually have multiple comorbidities, such as diabetes, hypertension, poor nutrition, less exercise tolerance, and sleep apnea which puts them on high risk for postoperative leaks.
All factors that improve intestinal blood flow and oxygen carrying capacity should be optimized preoperatively.These include anemia, iron, cardiac function, sleep apnea, preoperative hydration to prevent hypoperfusion and hypotension during surgery.Poor control of diabetes can adversely effect healing and HgbA1c should be stable and less than 6% prior to surgery.decreasing the size of the liver preoperatively affords better visualization of the operative field specially if its going to be a laparoscopic surgery.Steatohepatitis is frequently associated with morbid obesity and a two weeks preoperative low energy diet may help reduce the liver size thus resulting in a technically superior anastomosis.Specific preoperative antibiotic therapy may also help towards preventing postoperative anastomotic leak.