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Use of Intraoperative Provocative Leak Testing in Elective Laparoscopic Bariatric Procedures

Bhavani Pokala, MD, Priscila R Armijo, MD, Corrigan L Mcbride, MD, Dmitry Oleynikov, MD. University of Nebraska Medical Center

Introduction: Intraoperative leak testing (IOLT), surgical drains, and swallow studies are commonly employed for early detection of gastrointestinal leaks following bariatric surgery, however, their utility remains widely debated. Our aim was to examine the frequency and outcomes of IOLT with laparoscopic sleeve gastrectomy (LSG) and laparoscopic roux-en-y gastric bypass (LRYGB). 

Methods: The 2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project (MBSAQIP) database was analyzed for adults who underwent primary elective LSG or LRYGB. Emergent cases, those unable to be followed for 30 days, and patients with previous foregut or revisional surgery were excluded. Cases with IOLT and without IOLT (NIOLT) were compared within each procedure group. Statistical analysis was performed using IBM SPSS 25.0, α=0.05.

Results: 164,567 LSG patients (IOLT=126,291; NIOLT=38,276) and 70,148 LRYGB patients (IOLT=65,007; NIOLT=5,141) were included in the study. LSG with IOLT had higher rates of staple line reinforcement (69.2% vs 61.3%; p<.001), oversewing (22.5% vs 21.6%; p<.001), and surgical drain placement (21.3% vs 9.5%; p<.001) than LSG NIOLT. For LSG, both bariatric and general surgeons performed IOLT in majority of cases (77.4% and 66.9%, respectively). Mean operative time for LSG with IOLT was 77.2±37.1 minutes vs 64.7±30.7 minutes without. For LRYGB, cases with IOLT also had a higher rate of surgical drain placement (32.8% vs 21.8%; p<.001) than NIOLT. IOLT was performed routinely during LRYGB by bariatric (92.6%) and general surgeons (97.5%; p<.001). Mean operative time for LRYGB with IOLT was 116.8±51.7 minutes vs 106.0±47.8 minutes NIOLT. For both procedures, leak rates were higher with IOLT (LSG: 0.4% vs 0.3%; p<.001, LRYGB: 1.0% vs 0.4%, p<.001), however, logistic regression revealed that IOLT was not independently associated with post-operative leak.

Conclusions: IOLT is used in the vast majority of LSG and LRYGB cases. Our results show a statistically significant increase in operative time without significant decrease in post-operative leak rates in cases when IOLT was performed. Therefore, we suggest that IOLT may be unnecessary in elective LSG and LRYGB cases. In the future, MBSAQIP should consider capturing results of IOLT and discriminating between recurrent or previously undiagnosed leak in the post-operative setting.


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

Abstract ID: 95551

Program Number: P071

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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