S. Gambhir1, P. Yenumula1, C. Moon1, P. Haan1, S. Kavuturu1 1Michigan State University,Surgery,Lansign, MI, USA
Introduction: Routine Upper Gastrointestinal (UGI) x-ray use after laparoscopic Roux-en-y gastric bypass (LRYGB) is still practiced by many bariatric surgeons in order to investigate for anastomotic leaks.We present our experience with a large retrospective review of gastric bypass surgeries studying the usefulness of a routine drain placement.
Methods: Retrospective record of all patients undergoing LRYGB from September 2006 to November 2011 was performed. As we changed our practice in December 2009, we have two comparable groups; one with a routine UGI x-ray completed after surgery and one UGI was done selectively based on clinical suspicion and patient symptoms. A total of 613 LRYGBs were performed during the study period, the first 301 were routine UGI x-ray and the subsequent 312 without routine UGI x-ray. Demographics were statistically similar between the two groups.
Results:There were 3 leaks in the routine UGI group (1%) and 5 leaks in the selective UGI group (1.6%) (p >0.05). In the Routine UGI group, the sensitivity and specificity of the UGI to detect a leak are 25% and 99.7% respectively. Where as in the selective UGI group, the sensitivity and specificity of the UGI to detect a leak are 50% and 99.7% respectively. Clinical suspicion has a sensitivity and specificity of 100% and 99.3% in the routine UGI group, and 100% and 97.4% in the selective UGI group.
Conclusion: There is no difference in the leak rate or morbidity with routine use of UGI after a laparoscopic gastric bypass. Change in clinical parameters can accurately diagnose a patient with ongoing anastomotic leak. Selective use of UGI based on clinical suspicion for a leak is prudent and economically efficient.