Warren Sun, MD1, Jerry T Dang, MD1, Noah J Switzer, MD, MPH, FRCSC2, Daniel Birch, MD, MSc, FRCSC1, Shahzeer Karmali, MD, MPH, FRCSC1. 1University of Alberta, 2Ohio State University Wexner Medical Center
INTRODUCTION: We aim to study the diagnostic utility of routine UGI series for preoperative evaluation of LSG in our center. Laparoscopic sleeve gastrectomy (LSG) has become the most commonly performed primary bariatric procedure for the treatment of severe obesity in North America. However, there is no consensus for the preoperative diagnostic evaluation for patients undergoing LSG. The role of preoperative upper gastrointestinal (UGI) series to evaluate candidates for LSG is debatable.
METHODS AND PROCEDURES: A retrospective chart review for patients planning to undergo LSG with one surgeon at our hospital from May 2015 to April 2017 was completed. Primary outcomes included UGI findings and consequential changes in clinical management. Secondary outcomes included preoperative symptomology and postoperative complications.
RESULTS: 36 patients were identified from billing records of a single surgeon and were originally scheduled to undergo LSG. Four patients were male and 32 (88.9%) were female. The average age was 43.2 ± 2.1 years and average preoperative BMI was 47.3 ± 1.2 kg/m2. 22 (61.1%) patients underwent a preoperative UGI series, of which, 8 (36.4%) patients had hiatal hernias, 9 (40.9%) had gastroesophageal reflux, and 2 (9.1%) had dysmotility. Additionally, four (18.2%) of the 22 patients had a change from LSG to laparoscopic Roux-en-Y gastric bypass (LRYGB) due to significant reflux or dysmotility found on UGI. Patients who did not receive preoperative UGI received preoperative esophagogastroduodenoscopy (EGD) for a variety of reasons. 18 (50.0%) patients underwent a preoperative EGD, of which 4 (22.2%) had esophagitis and 5 (27.8%) had gastritis. One additional patient required a change of surgical management to LRYGB due to reflux found on EGD. Overall, 31 (86.1%) patients had LSG and 5 (13.9%) patients had LRYGB. The average postoperative BMI was 38.7 ± 1.4 kg/m2, after an average follow-up period of 8.3 ± 0.8 months. Four (11.1%) patients had postoperative complications, including two LSG requiring revision to LRYGB for reflux esophagitis, one LSG with dysphagia, and one LRYGB with a marginal ulcer.
CONCLUSION: Our cohort demonstrated that preoperative UGI has the potential to screen for pathology that may affect outcomes after LSG, and changed clinical management in almost one-fifth of patients undergoing UGI. Overall, UGI is a relatively simple and inexpensive test for the preoperative evaluation of patients before LSG.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95435
Program Number: P111
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster
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