Abstract
Background
The aim of this study was to determine the efficacy of routine upper gastrointestinal imaging following the three forms of laparoscopic bariatric surgery completed at our institution (laparoscopic Roux en Y gastric bypass (LRYGB), 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, 129 patients underwent LRYGB, 209 underwent LS, and 12 patients underwent LAGB. Of those patients, 120 LRYGB patients, 188 LS patients, and 11 LAGB patients underwent upper gastrointestinal studies on postoperative days (POD) 1 or 2.
Results
Of the 319 total patients who underwent UGI, no contrast leaks were found. One LRYGB patient was found to have stenosis of the jejunojejunal anastomosis and was taken to the operating room for revision. A total of ten patients went on to develop leaks: four LRYGB patients, six LS patients, and zero 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. Based on the results of this study, our institution has stopped completing routine UGI on POD 1 following bariatric surgery.
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References
Doraiswamy A, Rasmussen JJ, Pierce J, et al. The utility of routine postoperative upper GI series following laparoscopic gastric bypass. Surg Endosc. 2007;21:2159–62. doi:10.1007/s00464-007-9314-9.
Madan AK, Stoecklein HH, Ternovits CA, et al. Predictive value of upper gastrointestinal studies versus clinical signs for gastrointestinal leaks after laparoscopic gastric bypass. Surg Endosc. 2007;21:194–6. doi:10.1007/s00464-005-0700-x.
Singh R, Fisher BL. Sensitivity and specificity of postoperative upper GI series following gastric bypass. Obes Surg. 2003;13:73–5. doi:10.1381/096089203321136629.
Marquez MF, Ayza MF, Lozano RB, et al. Gastric leak after laparoscopic sleeve gastrectomy. Obes Surg. 2010;20:1306–11. doi:10.1007/s11695-010-0219-7.
Bertelson NL, Myers JA. Routine postoperative upper gastrointestinal fluoroscopy is unnecessary after laparoscopic adjustable gastric band placement. Surg Endosc. 2010;24:2188–91. doi:10.1007/s00464-010-0924-2.
Dallal RM, Bailey L, Nahmias N. Back to basics—clinical diagnosis in bariatric surgery. Routine drains and upper GI series are unnecessary. Surg Endosc. 2007;21:2268–71. doi:10.1007/s00464-007-9368-8.
Daylami R, Rogers AM, King TS, et al. Accuracy of upper gastrointestinal swallow study in identifying strictures after laparoscopic gastric bypass surgery. Surg Obes Relat Dis. 2008;4:96–9. doi:10.1016/j.soard.2007.06.001.
Carter JT, Tafreshian S, Campos GM, et al. Routine upper GI series after gastric bypass does not reliably identify anastomotic leaks or predict stricture formation. Surg Endosc. 2007;21:2172–7. doi:10.1007/s00464-007-9326-5.
Lee SD, Khouzam MN, Kellum JM, et al. Selective, versus routine, upper gastrointestinal series leads to equal morbidity and reduced hospital stay in laparoscopic gastric bypass patients. Surg Obes Relat Dis. 2007;3:413–6. doi:10.1016/j.soard.2007.04.006.
Lyass S, Khalili TM, Cunneen S, et al. Radiological studies after laparoscopic Roux-en-Y gastric bypass: routine or selective? Am Surg. 2004;70:918–21.
Sims TL, Mullican MA, Hamilton EC, et al. Routine upper gastrointestinal Gastrografin swallow after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13:66–72.
White S, Han SH, Lewis C, et al. Selective approach to use of upper gastroesophageal imaging study after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008;4:122–5. doi:10.1016/j.soard.2007.10.007.
Triantafyllidis G, Lazoura O, Sioka E, et al. Anatomy and complications following laparoscopic sleeve gastrectomy: radiological evaluation and imaging pitfalls. Obes Surg. 2011;21:473–8. doi:10.1007/s11695-010-0236-6.
Frezza EE, Mammarappallil JG, Witt C, et al. Value of routine postoperative gastrographin contrast swallow studies after laparoscopic gastric banding. Arch Surg. 2009;144:766–9. doi:10.1001/archsurg.2009.138.
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Brockmeyer, J.R., Simon, T.E., Jacob, R.K. et al. Upper Gastrointestinal Swallow Study Following Bariatric Surgery: Institutional Review and Review of the Literature. OBES SURG 22, 1039–1043 (2012). https://doi.org/10.1007/s11695-012-0658-4
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DOI: https://doi.org/10.1007/s11695-012-0658-4