Post-op Leak

Princples
- Source control
- Exclude distal obstruction
- Abx
- Nutrition
- Pyschosoical
- Treatment injury
- Communication with family and patient
Endoscopy
- Covered self-expanding metal stent (SEMS) to exclude the leak
- Endoscopic internal drainage (e.g. double pigtail stents into collection)
- Endoscopic vacuum-assisted closure (EndoVAC) for complex or chronic leaks
- Placement of feeding tubes (NJ)
External drian
- Try to avoid to prevent external fistula
- And removing any external drains early
Surgical
- Laparoscopic washout + drain placement
  - Indicated with generalised Peritonitis and sepsis
- Can consider of conversion of sleeve to RYGB
- Feeding jejunostomy placement

Stricture

Endoscopic diagnosis and initial management
- Dilatation 3-4mm at a time, aim 15mm
- Anything > 20mm will decrease restrictive effect of operation
If refractory – surgical revision of GJ, or convert a Sleeve to RYGB

Management is revision bariatric surgery
- Laparoscopic resection of the afferent limb