Routine Upper Gastrointestinal Imaging Is Superior to Clinical Signs for Detecting Gastrojejunal Leak after Laparoscopic Roux-en-Y Gastric Bypass - 23/01/12
, Robert B. Dorman, MD, PhD, Joel Anderson, BS, Federico J. Serrot, MD, Todd A. Kellogg, MD, FACS, Henry Buchwald, MD, PhD, FACS, Barbara K. Sampson, RN, MS, Bridget M. Slusarek, RN, BSN, Sayeed Ikramuddin, MD, FACS
Correspondence address: Daniel B Leslie, MD, FACS, Department of Surgery, University of Minnesota, 520 Delaware St SE, MMC 290, Minneapolis, MN 55455Résumé |
Background |
There are myriad symptoms and signs of gastrojejunal leak; prompt recognition is essential. Many surgeons use clinical predictors to guide selective use of upper gastrointestinal imaging (UGI). The appropriate practice remains undefined.
Study Design |
A review of patients who underwent primary laparoscopic Roux-en-Y gastric bypass between January 2002 and December 2008 was conducted. All underwent routine UGI studies on postoperative day 1. Actual gastrojejunal leak within 7 days of surgery (actual leak [AL], radiologic leaks), operative reports, patient charts, and postoperative vital signs were retrospectively reviewed.
Results |
There were 2,099 operations. Eight ALs (0.43%) occurred without associated mortality. UGI was positive in 7 AL patients and falsely positive in 6 patients. The AL patients underwent laparoscopy on postoperative days 1 and 3 (n = 5 and n = 1, respectively), laparotomy on postoperative day 3 (n = 1), and peritoneal drainage (n = 1). False-positive UGIs prompted laparoscopy (n = 3) and close observation (n = 3). Pulse was 100 to 120 beats per minute in 2 patients and fever (>38.5°C) was present in 0 AL patients. AL patients had osteogenesis imperfecta (n = 1), macronodular cirrhosis (n = 1), positive bubble test (n = 3), and concomitant splenectomy (n = 1). No jejunojejunostomy leaks were identified.
Conclusions |
Routine UGI after laparoscopic Roux-en-Y gastric bypass has greater sensitivity than clinical signs for detecting gastrojejunal leak. Delay in the diagnosis of leakage can impact mortality, and this suggests that indications for routine UGI might still exist. Tachycardia is not a reliable early marker of leak. There might be risk factors for leak in addition to vital signs, including patient medical history or intraoperative events, which should prompt routine UGI on postoperative day 1.
Le texte complet de cet article est disponible en PDF.Abbreviations and Acronyms : AL, bpm, GJ, JJ, LRYGB, POD, RL, RYGB, UGI
Plan
| Disclosure Information: Drs Leslie and Ikramuddin, Ms Sampson, and Ms Slusarek receive a fee as consultants for Ethicon Endo-Surgery; Dr Dorman receives a salary (sponsored fellowship) as a research fellow for Ethicon Endo-Surgery; Dr Buchwald received a fee in the past as a consultant for Ethicon Endo-Surgery and receives a fee as a consultant and research funds as principal investigator for Metacure, Inc.; and Dr Ikramuddin receives a fee as consultant and receives research funds as principal investigator for Covidien, research funds as principal investigator for Enteromedics, research funds in the past as principal investigator for Satiety, Inc., and a fee as a consultant for Metamodix and OptumHealth. All other authors have nothing to declare. |
Vol 214 - N° 2
P. 208-213 - février 2012 Retour au numéro
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