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The utility of routine postoperative upper GI series following laparoscopic gastric bypass

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Abstract

Background

Routine upper gastrointestinal (UGI) studies following laparoscopic Roux-en-Y gastric bypass (LRYGBP) have the potential advantage of early identification of anastomotic complications. The aim of our study was to evaluate the efficacy of routine postoperative UGI and its relationship to clinical outcomes.

Methods

Over a three-year period, 516 patients underwent LRYGBP followed by routine postoperative UGI studies. Data were collected on the results of the UGI, clinical parameters, and patient outcomes. Study groups were composed of patients with a normal UGI (Group I, n = 455), abnormal UGI not requiring further intervention (Group II, n = 36), and abnormal UGI requiring further intervention (Group III, n =25). Statistical significance was set at α= 0.05 level for all analyses.

Results

The three study groups were not statistically different in mean age (42 years) or body mass index (BMI) (45) and were predominantly female (90%). Most patients had an uneventful postoperative course. Anastomotic complications (gastrojejunostomy and jejunojejunostomy) were uncommon (1.3%). The sensitivity of the UGI for anastomotic leak in this study was low (33%). However, all patients with alimentary limb obstruction (n = 3) had UGI evidence of this complication. Of the 516 UGI reports, there were only 25 (4.8%, Group III) that were abnormal and required some form of intervention ranging from serial imaging (84%) to reoperation (16%). Of the various clinical parameters examined, the patients in Group III demonstrated a significantly higher prevalence of fever (p < 0.001), tachycardia (p < 0.01), vomiting (p < 0.001), and postoperative day 1 leukocytosis (p < 0.005).

Conclusions

Our data suggest that routine UGI after LRYGBP has limited utility as it may result in unnecessary intervention based on false-positive results or a delay in treatment based on false-negative results. We advocate selective UGI imaging following LRYGBP based on the patient’s clinical factors, particularly fever and tachycardia.

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Acknowledgments

The authors thank Mr. William Smith for his assistance in accumulating data and Mrs. Marie Carvidi for her editorial assistance. This research was supported by a research grant from Stryker Endoscopy.

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Authors and Affiliations

  1. Department of Surgery, University of California, Davis, Sacramento, CA, USA

    Asok Doraiswamy, Jason J. Rasmussen, Jonathan Pierce, William Fuller & Mohamed R. Ali

  2. Minimally Invasive Surgery, Department of Surgery, University of California, Davis, 2221 Stockton Boulevard, Sacramento, CA, 95817, USA

    Mohamed R. Ali

Authors
  1. Asok Doraiswamy
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  2. Jason J. Rasmussen
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  3. Jonathan Pierce
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  4. William Fuller
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  5. Mohamed R. Ali
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Corresponding author

Correspondence to Mohamed R. Ali.

Additional information

Poster presentation at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Las Vegas, Nevada, April 2007

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Doraiswamy, A., Rasmussen, J.J., Pierce, J. et al. The utility of routine postoperative upper GI series following laparoscopic gastric bypass. Surg Endosc 21, 2159–2162 (2007). https://doi.org/10.1007/s00464-007-9314-9

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  • DOI: https://doi.org/10.1007/s00464-007-9314-9

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