Expert: John Pilcher, MD - 4/16/2009

Question
QUESTION: Does the bowel repair itself of leaks/nicks? Can there be pockets of fluid in the abdominal cavity of bile and fecal matter and what damage would this do to the internal organs?

ANSWER: Andrea,
The intestine (including stomach, small bowel, and colon) have very limited ability to repair themselves, UNLESS the leaking fluid is evacuated steadily away from the area of leakage and out of the body.  If intestinal fluids (such as bile and fecal matter) remain inside the body then they will create a condition known as peritonitis, which will then go on to a devastating infection.

In the setting of a gastric bypass leak, it is often appropriate to treat the leak by using plastic drain tubes to draw out the leaking fluid, and set up an environment in which the leak may heal over some weeks.  Surgery for such a leak is usually employed only if drains do not successfully evacuate the fluid.

I hope this is helpful for you, and best of luck,
Dr JP

---------- FOLLOW-UP ----------

QUESTION: What if drains have been used for over 5 weeks and the drainage continues? will VAC therapy over the incision line that has been dehissed to allow for drainage be effective in removing the bile/fecal matter from the abdominal cavity? How long to continue using these methods before getting another opinion? How long is the recovery time for issues such as this?

Answer
Andrea,
What you are describing is technically called a "fistula."  The management of this type of problem is very complex, long, and individualized to each particular situation, so it is not really practical for me to give you set answers to your questions but I will give you a few generalizations.

Whatever gets the intestinal material, which we call succus, out of the abdomen most effectively is the right thing to do.  This may be a VAC, and drains, or just gauze to soak up the succus, or placement of an ostomy bag over the leaking wound, or any combination of these.

There is no set time at which these plans should be abandoned and surgery should be done.  It is usually the case that surgery should be delayed at least 3 months from the preceding operation, to allow the inflammation to settle down and to minimize the trauma of the re-operation if it is necessary.  Even so, there is nothing magic about 3 months and if non-surgical management is still making progress then it is usually best to continue that strategy until healing is complete or until no progress is being made.

Dr JP