The utility of contrast studies and drains in the management of patients after Roux-en-Y gastric bypass.
BACKGROUND
The role of routine post-operative contrast examination (UGI) and drainage of the gastrojejunostomy after Roux-en-Y gastric bypass (RYGBP) is controversial. The authors determined if early routine post-operative UGI detects occult anastomotic leaks, thereby altering treatment and withholding early feeding.


METHODS
Prospective data on 100 consecutive patients who underwent RYGBP from September 1998 to September 2000 was reviewed. Closed suction drains were routinely used. Within 36 hr post-operatively, all patients underwent UGI to evaluate the gastrojejunostomy. Patients were given liquids if the UGI showed no leak, and drains were removed 24 hr later. A blinded radiologist reviewed all the UGI.


RESULTS
87 women and 13 men underwent 75 open and 25 laparoscopic RYGBP. BMI was 52.0 kg/m2. 3 patients whose UGI showed a leak were treated non-operatively with antibiotics, maintenance of drains, nasogastric tube and NPO. 2 of those patients developed purulent drainage within 24 hr after the UGI. None of the three patients required reoperation. 4 UGI were not available for the blinded reviewer who graded the remaining as satisfactory (94) and unsatisfactory (2). This reviewer disputed a leak in 1 of 3 previously reported leaks and reported a leak in a previously negative study. The latter patient subsequently required surgery for an uncontrolled leak.


CONCLUSIONS
UGI can be used to withhold early oral intake in patients with radiographic leaks that would otherwise progress to clinically significant leaks. Surgical drains facilitate the non-operative management of such anastomotic leaks. Planned early UGI and surgical drains minimize the morbidity of anastomotic leaks after bariatric surgery.
Serafini
Francesco
F
Department of Surgery, Interdisciplinary Obesity Treatment Group, University of South Florida, Tampa, FL, USA.
Anderson
Wayne
W
Ghassemi
Poopak
P
Poklepovic
Jerry
J
Murr
Michel M
MM
D000328:Adult; D000713:Anastomosis, Roux-en-Y; D003287:Contrast Media; D003974:Diatrizoate Meglumine; D004322:Drainage; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies
D003287:Contrast Media; D003974:Diatrizoate Meglumine