Role of routine intraoperative endoscopy in laparoscopic bariatric surgery.
BACKGROUND
Laparoscopic bariatric surgery is a challenging procedure with a high risk of technical misadventures that may increase postoperative morbidity. Routine intraoperative endoscopy may reduce postoperative morbidity. This article reviews our 6-year experience.


METHODS
From April 1995 to September 2001, we performed 825 laparoscopic bariatric procedures: 743 roux gastric bypasses, 55 vertical banded gastroplasties, 18 laparoscopic adjustable gastric bands, and 9 gastric pacemakers. All the patients underwent flexible endoscopy by the primary surgeon at completion of the operation to assess for technical errors.


RESULTS
The 34 intraoperative technical errors (4.1%) identified included 29 suture and staple line leaks, 2 bougie perforations, 2 inadvertent stoma closures secondary to the suture line, and 1 mucosal perforation in a gastric pacemaker. All the errors were successfully repaired laparoscopically at the time of the procedure. Three leaks occurred postoperative (0.36%): 1 in the 34 repaired errors (2.9%) and 2 in the remaining 791 patients (0.25%).


CONCLUSIONS
Routine intraoperative endoscopy identified 34 correctable technical errors in a series of 825 laparoscopic bariatric procedures. Of these, 33 (97%) were repaired successfully, which reduced postoperative morbidity.
Champion
J K
JK
Department of Surgery, Emory Dunwoody Medical Center, 4575 North Shallowford Road, Atlanta, GA 30338, USA. jkchamp@june.com
Hunt
T
T
DeLisle
N
N
D000293:Adolescent; D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D004558:Electric Stimulation / Q000295:instrumentation / Q000379:methods; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods*; D005769:Gastrointestinal Motility / Q000502:physiology; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D007431:Intraoperative Complications / Q000453:epidemiology / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D013270:Stomach / Q000601:surgery