Utility of routine versus selective upper gastrointestinal series to detect anastomotic leaks after laparoscopic gastric bypass

M Schiesser, J Guber, S Wildi, I Guber, M Weber, M K Muller
2011
BACKGROUND: In up to 4% of laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures, anastomotic leaks occur. Early detection of gastrointestinal leakage is important for successful treatment. Consequently, many centers advocate routine postoperative upper gastrointestinal (UGI) series. The aim of this study was to determine the utility of this practice after LRYGB. METHODS: Eight hundred four consecutive patients undergoing LRYGB from June 2000 to April 2010 were analyzed prospectively. The
more » ... ospectively. The first 382 patients received routine UGI series between the third and fifth postoperative days (group A). Thereafter, the test was only performed when clinical findings (tachycardia, fever, and drainage content) were suspicious for a leak of the gastrointestinal anastomosis (group B; n = 422). RESULTS: Overall, nine of 804 (1.1%) patients suffered from leaks at the gastroenterostomy. In group A, four of 382 (1%) patients had a leak, but only two were detected by the routine UGI series. This corresponds to a sensitivity of 50%. In group B, the sensitivity was higher with 80%. Specificities were comparable with 97% and 91%, respectively. Routine UGI series cost only 1.6% of the overall costs of a non-complicated gastric bypass procedure. With this leak rate and sensitivity, US 86, 800wouldhavetobespenton200routineU GIseriestof indoneleakwhichisnotjustif ied.CON CLU SION S : T hisstudyshowsthatroutineU GIserieshavealowsensitivityf orthedetectionof anastomoticleaksaf terLRY GB.Inmostca
doi:10.5167/uzh-45963 fatcat:5jfqooqjwzgbbfstpvf35ukrpy