Should routine UGI after bypass be standard of care?

Gregory J Coffman, MD, MS

Ochsner Clinic Foundation

Because of the risk of significant morbidity and mortality in bariatric patients routine upper GI (UGI) is used postoperatively for early identification of complications such as gastro-jejunal leak. Our program, as well as many others, has adopted routine use of post operative day one UGI. There is controversy in the literature regarding the sensitivity of UGI versus clinical signs for timely and accurately identification of complications. The purpose of this study is to determine the necessity of UGI studies after gastric bypass surgery.

METHOD AND MATERIALS
This was a retrospective study using a prospectively gathered patient database. Inclusion criteria were patients who had an open or laparoscopic roux-en-y gastric bypass at Ochsner Clinic Foundation. Primary outcome variables were anastomotic leak, delayed gastric emptying, gastric outlet obstruction or fistula formation, either by radiographic analysis or operative exploration. Secondary outcome variables were any of the clinical signs of post-surgical complications: nausea or vomiting, temperature greater than 101, heart rate greater than 120, WBC >12,000.

RESULTS
Nine-hundred fifty-six patients met inclusion criteria. Eleven patients had delayed gastric emptying, five gastric outlet obstruction and three leaks were identified by UGI. None of these patients required operative intervention. There was one negative UGI where leak was identified by CT 21 days later and reoperation was performed. There were no other false negatives. For every abnormal UGI there was at least one clinical sign. There were no deaths in this series.

CONCLUSION
This large study failed to demonstrate the need for the routine use of post operative UGI. There is a false negative rate with UGI for leak and clinical signs must be evaluated properly. Larger studies will have to be performed to confirm our findings.


Session: Podium Presentation

Program Number: S095

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