Micropouch gastric bypass: indications for gastrostomy tube placement in the bypassed stomach.
BACKGROUND
Since 1994 we have performed the "micropouch" gastric bypass (MGB) procedure for morbid obesity. In our MGB operation, the transected gastric reservoir is limited to the cardia of the stomach. The Roux and biliopancreatic limbs measure 200 and 150 cm, respectively; radiographic or endoscopic access to the bypassed stomach is therefore excluded.


METHODS
A retrospective analysis of 1,120 MGB operations revealed that 33 patients (2.9%) developed a potentially life-threatening postoperative complication requiring emergency re-operation or prolonged hospitalization. Complications included anastomotic leaks, fascial dehiscence, gastro-enteric obstructions, peptic ulcers, and pancreatitis. Each complication was analyzed to determine if gastrostomy tube (G-tube) placement at the time of gastric bypass could have affected complication outcome or obviated the need for repeat laparotomy.


RESULTS
In 19 patients (1.6% of total cohort), G-tube placement would have significantly affected complication outcome. In four instances, it would have prevented emergency re-operation.


CONCLUSIONS
Routine gastrostomy tube placement at the time of gastric bypass is not necessary in all patients. For patients who are at high risk for a gastro-enteric obstruction or an anastomotic leak, G-tube placement is recommended and is often therapeutic.
Wood
M F
MF
St. John Detroit Riverview Hospital, Detroit, MI, USA. michael.wood@stjohn.org
Sapala
J A
JA
Sapala
M A
MA
Schuhknecht
M P
MP
Flake
T M
TM
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D005774:Gastrostomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D012086:Reoperation; D012189:Retrospective Studies