Routine upper gastrointestinal Gastrografin swallow after laparoscopic Roux-en-Y gastric bypass.
BACKGROUND
Upper gastrointestinal (UGI) swallow radiographs following laparoscopic Roux-en-Y gastric bypass (LRYGBP) may detect an obstruction or an anastomotic leak. The aim of our study was to determine the efficacy of routine imaging following LRYGBP.


METHODS
Radiograph reports were reviewed for 201 consecutive LRYGBP operations between April 1999 and June 2001. UGI swallow used Gastrografin, static films, fluoroscopic video, and a delayed image at 10 minutes. Mean values with one standard deviation were tested for significance (P < 0.05) using the Mann-Whitney U test statistic.


RESULTS
Of 198 available reports, UGI detected jejunal efferent (Roux) limb narrowing (n = 17), partial obstruction (n = 12), anastomotic leak (n = 3), complete bowel obstruction (n = 3), diverticulum (n = 1), hiatal hernia (n = 1), and proximal Roux limb narrowing (n = 1). A normal study was reported in 160 cases (81%). Partial obstruction resolved without intervention. Complete obstruction required re-operation. Compared to 6 patients who developed delayed leaks, early identification of a leak by routine UGI swallow resulted in a shorter hospital stay (mean 7.7 +/- 1.5 days vs 40.2 +/- 12.3 days, P < 0.03).


CONCLUSIONS
Early intervention after UGI swallow may lessen morbidity. Routine UGI swallow following LRYGBP does not obviate the importance of close clinical follow-up.
Sims
Thomas L
TL
Southwestern Center for Surgery for Obesity, Southwestern Center for Minimally Invasive Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75235-9092, USA.
Mullican
Mary A
MA
Hamilton
Elizabeth C
EC
Provost
David A
DA
Jones
Daniel B
DB
D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D015992:Body Mass Index; D003287:Contrast Media; D003955:Diagnostic Tests, Routine; D003974:Diatrizoate Meglumine; D004064:Digestive System / Q000000981:diagnostic imaging*; D015390:Gastric Bypass / Q000009:adverse effects; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008875:Middle Aged; D011184:Postoperative Period; D011859:Radiography; D012189:Retrospective Studies
D003287:Contrast Media; D003974:Diatrizoate Meglumine