Clinical predictors of leak after laparoscopic Roux-en-Y gastric bypass for morbid obesity.
BACKGROUND
Gastrointestinal leak is a complication of laparoscopic Roux-en-Y gastric bypass (LRYGB). Contrast studies may underdiagnose leaks, forcing surgeons to rely solely on clinical data. This study was designed to evaluate various clinical signs for detecting leakage after LRYGB.


METHODS
We retrospectively reviewed 210 consecutive patients who underwent LRYGB between April 1999 and September 2001. There were nine documented leaks (4.3%). Clinical signs between patients with leaks (group 1) and those without leaks (group 2) were compared using univariate and multivariate logistic regression analysis.


RESULTS
Evidence of respiratory distress and a heart rate exceeding 120 beats per min were the two most sensitive indicators of gastrointestinal leak. Routine upper gastrointestinal contrast imaging detected only two of nine leaks (22%).


CONCLUSIONS
Leak after LRYGB may be difficult to detect. Evidence of respiratory distress and tachycardia exceeding 120 beats per min may be the most useful clinical indicators of leak after laparoscopic Roux-en-Y gastric bypass.
Hamilton
E C
EC
Clinical Center for the Surgical Management of Obesity and the Southwestern Center for Minimally Invasive Surgery, University of Texas Southwestern Medical Center, Dallas, 75390, USA.
Sims
T L
TL
Hamilton
T T
TT
Mullican
M A
MA
Jones
D B
DB
Provost
D A
DA
D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D004322:Drainage; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods* / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D012128:Respiratory Distress Syndrome / Q000209:etiology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017792:Surgical Stapling / Q000009:adverse effects / Q000706:statistics & numerical data; D013610:Tachycardia / Q000209:etiology