title: Is a routine liquid contrast swallow following laparoscopic gastric banding mandatory?
abstract: BACKGROUND
  The authors assess the value of liquid contrast medium swallow as a method to detect postoperative complications after laparoscopic adjustable gastric banding (LAGB) for the treatment of morbid obesity.
  
  
  METHODS
  From January 1996 to January 2001, 350 morbidity obese patients (295 women, 55 men) underwent a LAGB operation. All data were prospectively collected in a computerized databank. All patients underwent a jopomidol swallow (JS) study in the early postoperative phase to exclude perforation of the esophagus or stomach, which is one of the most serious complications occurring after the LAGB operation. Furthermore, the JS was performed to confirm band position and to exclude early pouch dilatation.
  
  
  RESULTS
  Out of the 350 LAGB operations, 6(1.8%) early pouch dilatations and 4(1.2%) stomach perforations occurred. All early pouch dilatations were recognized on postoperative JS and immediately repaired laparoscopically. Of the perforations, one was recognized intraoperatively, and the other three were diagnosed postoperatively, either by contrast media extravasation on the JS (two patients) or by computer tomography.
  
  
  CONCLUSIONS
  Presently, all patients undergo routine postoperative JS, which exposes them to radiation, causes patient discomfort, and entails additional costs of approximately 100 US$ per patient. Of the last 250 patients in our series, there have not been any cases of early pouch dilatation and since 1998 only one case of perforation has occurred, which could be easily suspected clinically. Therefore, we believe that in experienced centers, it is not necessary to perform routine postoperative contrast media studies and recommend JS only in cases of complicated postoperative courses.
authors.affiliation: Department of General Surgery, University Hospital of Innsbruck, Anichstr. 35, Innsbruck, Austria. hermann.nehoda@uibk.ac.at
authors.forename: H
authors.initials: H
authors.lastname: Nehoda
authors.forename: K
authors.initials: K
authors.lastname: Hourmont
authors.forename: R
authors.initials: R
authors.lastname: Mittermair
authors.forename: M
authors.initials: M
authors.lastname: Lanthaler
authors.forename: T
authors.initials: T
authors.lastname: Sauper
authors.forename: R
authors.initials: R
authors.lastname: Peer
authors.forename: F
authors.initials: F
authors.lastname: Aigner
authors.forename: H
authors.initials: H
authors.lastname: Weiss
mesh_terms: D000328:Adult; D003287:Contrast Media; D004108:Dilatation, Pathologic / Q000175:diagnosis / Q000209:etiology; D004939:Esophageal Perforation / Q000000981:diagnostic imaging; D005119:Extravasation of Diagnostic and Therapeutic Materials; D005260:Female; D015391:Gastroplasty / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007479:Iopamidol; D010535:Laparoscopy; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D013270:Stomach / Q000000981:diagnostic imaging* / Q000293:injuries; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D007479:Iopamidol