Joel R Brockmeyer, MD, Todd E Simon, DO, Richard K Jacob, MD, Farah Husain, MD, Yong Choi, MD. D. D. Eisenhower Army Medical Center
Background: Upper gastrointestinal (UGI) swallow radiographs following laparoscopic bariatric surgery may detect an obstruction, staple line leak, or anastomotic leak. The aim of this study was to determine the efficacy of routine imaging following the three forms of laparoscopic bariatric surgery completed at our institution, laparoscopic Roux en Y gastric bypass (LRYGBP), laparoscopic sleeve gastrectomy (LS), and laparoscopic adjustable gastric banding (LAGB).
Methods: Radiograph reports were reviewed from the period of January 2005 to July 2010. During that time, 121 patients underwent LRYGBP, 164 underwent LS, and 12 patients underwent LAGB. All patients received intraoperative leak tests. Of those patients, 111 LRYGBP patients, 147 LS patients, and 11 LAGB patients underwent UGI on postoperative days 1 or 2.
Results: Of the 269 total patients who underwent UGI, no contrast leaks were found. 1 LRYGBP patient was found to have stenosis of the jejunojejunal anastomosis and was taken to the operating room for revision. A total of 5 patients went on to develop leaks: 2 LRYGBP patients, 3 LS patients, and 0 LAGB patients.
Conclusions: The results of our study show that a positive UGI study for stricture has a specificity of 100%. In terms of leak, which offers a much higher risk of significant morbidity and mortality, UGI was unable to find any on postoperative days 1 or 2. However, swallow studies have continued at our institution for the purpose of verifying final anatomy for future use and evaluating the efficacy of UGI following bariatric surgery. In light of our findings, routine postoperative UGI may be discontinued in favor of only intraoperative leak tests.
Program Number: P063