• Skip to main content
  • Skip to header right navigation
  • Skip to site footer

Log in
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
www.sages.org

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Awards
    • Who Is SAGES?
    • Leadership
    • Our Mission
    • Advocacy
    • Committees
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Committee Rosters
      • SAGES Past Presidents
  • Meetings
    • SAGES NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2026 Scientific Session Call for Abstracts
      • 2026 Emerging Technology Call for Abstracts
    • CME Claim Form
    • SAGES Past, Present, Future, and Related Meeting Information
    • SAGES Related Meetings & Events Calendar
  • Join SAGES!
    • Membership Application
    • Membership Benefits
    • Membership Types
      • Requirements and Applications for Active Membership in SAGES
      • Requirements and Applications for Affiliate Membership in SAGES
      • Requirements and Applications for Associate Active Membership in SAGES
      • Requirements and Applications for Candidate Membership in SAGES
      • Requirements and Applications for International Membership in SAGES
      • Requirements for Medical Student Membership
    • Member Spotlight
    • Give the Gift of SAGES Membership
  • Patients
    • Join the SAGES Patient Partner Network (PPN)
    • Patient Information Brochures
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find A SAGES Surgeon
  • Publications
    • Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Sustainability in Surgical Practice
    • SAGES Stories Podcast
    • Patient Information Brochures
    • Patient Information From SAGES
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • MesSAGES – The SAGES Newsletter
    • COVID-19 Archive
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • Avoid Opiates After Surgery
    • SAGES Subscription Catalog
    • SAGES TV: Home of SAGES Surgical Videos
    • The SAGES Safe Cholecystectomy Program
    • Masters Program
    • Resident and Fellow Opportunities
      • MIS Fellows Course
      • SAGES Robotics Residents and Fellows Courses
      • SAGES Free Resident Webinar Series
      • Fluorescence-Guided Surgery Course for Fellows
      • Fellows’ Career Development Course
    • SAGES S.M.A.R.T. Enhanced Recovery Program
    • SAGES @ Cine-Med Products
      • SAGES Top 21 Minimally Invasive Procedures Every Practicing Surgeon Should Know
      • SAGES Pearls Step-by-Step
      • SAGES Flexible Endoscopy 101
    • SAGES OR SAFETY Video Activity
  • Opportunities
    • Fellowship Recognition Opportunities
    • SAGES Advanced Flexible Endoscopy Area of Concentrated Training (ACT) SEAL
    • Multi-Society Foregut Fellowship Certification
    • Research Opportunities
    • FLS
    • FES
    • FUSE
    • Jobs Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • OWLS/FLS
You are here: Home / Abstracts / Managing a Positive Air-Leak Test During a Gastrojejunostomy Revision

Managing a Positive Air-Leak Test During a Gastrojejunostomy Revision

Matthew J Davis, MD, Dvir Froylich, MD, Gautam Sharma, Tammy S Fouse, DO, Philip R Schauer, MD, Stacy A Brethauer, MD. Bariatric and Metabolic Institute, Cleveland Clinic Foundation

Introduction: Gastrojejunostomy revision after gastric bypass surgery is a challenging procedure. The air-leak test is widely viewed as reliable in evaluating the integrity of the gastrojejunal anastomosis. We present a case with a positive air-leak test during gastrojejunostomy revision and the techniques employed to address it.

Case Presentation: A 40-year-old female, who underwent laparoscopic gastric bypass 6 years prior, subsequently developed a chronic stricture due to marginal ulceration at her gastrojejunostomy. Over time, this resulted in severe food intolerance, nausea, and vomiting. The patient underwent multiple endoscopic dilations over 1 year, however, the stricture persisted. Thus, surgical intervention was planned.

Six ports were utilized, four 5 mm, and two 12 mm. After lysis of dense adhesions, dissection of the gastric pouch was continued up to the right crus. The remnant stomach and gastric pouch were found to be intimately adherent. The greater curvature attachments were divided along with the gastroepiploic arcade up to the left crus. The lesser sac was entered and a retrocolic, retrogastric Roux limb was identified. Remnant gastrectomy was performed at the junction of the body and the antrum using a stapler. The Roux limb was divided, the gastrojejunostomy was fully mobilized and the previous pouch was divided just below the left gastric pedicle. Endoscopic leak test on the pouch staple line was found to be negative. The gastrojejunal anastomosis was performed with a posterior layer of 2-0 non-absorbable suture, followed by a linearly stapled gastrojejunostomy. The common enterotomy was closed with 2 strands of running 2-0 absorbable sutures tied over the endoscope. The anterior aspect of the anastomosis was then imbricated with 2-0 non-absorbable suture. A leak test showed air bubbles at the lateral aspect of the anastomosis. Attempts to rectify this with figure-of-eight sutures were unsuccessful. Thus, fibrin glue and a tongue of omentum were placed over the gastrojejunostomy. Remnant gastrostomy was performed in the standard fashion. Two closed suction drains were placed. Upper endoscopy at the end of the case demonstrated a patulous gastrojejunostomy. Post-operative course was uneventful. Enteric feeding was successfully initiated via the remnant gastrostomy. Upper GI fluoroscopy was performed on post-operative day five and was negative for leak or stricture. The patient was discharged on post-operative day seven.

Conclusion: In this video, we have demonstrated a complex gastrojejunostomy revision with successful management of a positive intra-operative air-leak test using suture reinforcement, fibrin sealant agent and an omental tongue encircling the anastomosis.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 79781

Program Number: V079

Presentation Session: Friday Exhibit Hall Video Presentations Session 2 (Non CME)

Presentation Type: EHVideo

307

Share this:

  • Click to share on X (Opens in new window) X
  • Click to share on Facebook (Opens in new window) Facebook
  • Click to share on LinkedIn (Opens in new window) LinkedIn
  • Click to share on Pinterest (Opens in new window) Pinterest
  • Click to share on WhatsApp (Opens in new window) WhatsApp
  • Click to share on Reddit (Opens in new window) Reddit
  • Click to share on Pocket (Opens in new window) Pocket
  • Click to share on Mastodon (Opens in new window) Mastodon
  • Click to share on Threads (Opens in new window) Threads
  • Click to share on Bluesky (Opens in new window) Bluesky

Related


sages_adbutler_leaderboard

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064

1-310-437-0544

[email protected]

Monday – Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Bluesky
  • X
  • Instagram
  • Facebook
  • YouTube

Copyright © 2025 · SAGES · All Rights Reserved

Important Links

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals